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Echocardiographic examination of mitral valve abnormalities in the paediatric population: current practices

Published online by Cambridge University Press:  08 January 2020

Massimiliano Cantinotti ,
Raffaele Giordano Open the ORCID record for Raffaele Giordano [Opens in a new window] ,
Martin Koestenberger ,
Inga Voges ,
Giuseppe Santoro ,
Eliana Franchi ,
Nadia Assanta ,
Israel Valverde Open the ORCID record for Israel Valverde [Opens in a new window] ,
John Simpson  and
Shelby Kutty Open the ORCID record for Shelby Kutty [Opens in a new window]
Massimiliano Cantinotti
Affiliation:
Fondazione G. Monasterio CNR-Regione Toscana, Massa, Italy
Raffaele Giordano*
Affiliation:
Department of Advanced Biomedical Sciences, Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy
Martin Koestenberger
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
Inga Voges
Affiliation:
Cardiovascular Magnetic Resonance Unit, Department of Paediatrics, Royal Brompton and Harefield Hospital, London, UK
Giuseppe Santoro
Affiliation:
Fondazione G. Monasterio CNR-Regione Toscana, Massa, Italy
Eliana Franchi
Affiliation:
Fondazione G. Monasterio CNR-Regione Toscana, Massa, Italy
Nadia Assanta
Affiliation:
Fondazione G. Monasterio CNR-Regione Toscana, Massa, Italy
Israel Valverde
Affiliation:
Hospital Virgen de Rocio/CSIC/University of Seville, Seville, Spain
John Simpson
Affiliation:
Evelina London Children’s Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
Shelby Kutty
Affiliation:
Taussig Heart Center, Johns Hopkins Hospital and School of Medicine, 1800 Orleans St, Baltimore, MD, USA
*
Author for correspondence: R. Giordano, MD, PhD, Department of Advanced Biomedical Sciences, Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy. Tel: +390817464702; Fax: +390817464702; E-mail: [email protected]
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Abstract

We reviewed the recent literature for echocardiographic assessment of mitral valve abnormalities in children. A literature search was performed within the National Library of Medicine using the keywords “mitral regurgitation and/or stenosis, children.” The search was refined by adding the keywords “echocardiographic definition, classification, and evaluation.” Thirty-one studies were finally included. Significant advances in echocardiographic imaging of mitral valve defects, mainly due to the implementation of three-dimensional technology, contribute to a better understanding of the underlying anatomy. However, heterogeneity between classification systems of mitral valve disease severity is a serious problem. For regurgitant lesions, there is only very limited evidence from small studies that support the adoption of quantitative/semi-quantitative indexes commonly employed in adults. Despite the lack of evidence base, qualitative evaluation of regurgitation severity is often employed. For stenotic lesions, no clear categorisation based on trans-valvular echocardiography-derived “gradients” has been consistently applied to define mild, moderate, or severe obstruction across different paediatric age ranges. Quantitative parameters such as valve area have also been poorly validated in children. Adult recommendations are frequently applied without validation for the paediatric age. In conclusion, significant advances in the anatomical evaluation of mitral valve diseases have been made, thanks to three-dimensional echocardiography; however, limitations remain in the quantitative/semi-quantitative estimation of disease severity, both with respect to valvular regurgitation and stenosis. Because adult echocardiographic recommendations should not be simply translated to the paediatric age, more specific paediatric guidelines and standards for the assessment of mitral valve diseases are needed.

Keywords

Echocardiographychildrenvalvular disease
Type
Review Article
Information
Cardiology in the Young , Volume 30 , Issue 1 , January 2020 , pp. 1 - 11
Copyright
© Cambridge University Press 2020

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