Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-26T12:56:00.651Z Has data issue: false hasContentIssue false
  • English
  • Français

Valvar regurgitation in normal children: Is it clinically significant?

Published online by Cambridge University Press:  19 August 2008

Sandra da Silva Mattos ,
Rossana Severi ,
Catarina Vasconcelos Cavalcanti ,
Monica da Fonte Freire  and
Djair Brindeiro Filho
Sandra da Silva Mattos*
Affiliation:
Instituto do Coração de Pernambuco, Recife
Rossana Severi
Affiliation:
Instituto do Coração de Pernambuco, Recife
Catarina Vasconcelos Cavalcanti
Affiliation:
the Serviço de Ecocardiografia do Recife, Recife
Monica da Fonte Freire
Affiliation:
the Serviço de Ecocardiografia do Recife, Recife
Djair Brindeiro Filho
Affiliation:
the Serviço de Ecocardiografia do Recife, Recife
*
Dr. Sandra S. Mattos, Instituto do Coração de Pernambuco, Avenida Portugal, 163, Recife, 50.010, Brazil. Tel. 081-231-5968; Fax. 081-421-2473.
Get access Rights & Permissions [Opens in a new window]

Summary

This study aimed to assess the prevalence of “silent” valvar regurgitation in healthy Brazilian children; to determine whether variations in the gain settings of the machine interfered with its documentation; and to compare Doppler color flow mapping with the pulsed wave Doppler. Twenty-five healthy children were selected randomly. Echocardiographic equipment used was ALOKA 870. Fixed parameters were 3.5 MHz transducer, 400 Hz filter, reject of 7/14 and aperture of 30/80. Variable parameters were Doppler color flow mapping and pulsed wave Doppler gains. A protocol for evaluation of each cardiac valve was developed. Regurgitation was noted in 93% for the pulmonary valve, 74% for the tricuspid valve and 27% for the mitral valve. In the aortic valve, jets suggestive of mild valvar regurgitation were observed with the Doppler color flow mapping technique in two children but these findings were not corroborated by pulsed wave Doppler. Only in the aortic valve were findings from Doppler color flow mapping not in agreement with those from pulsed wave Doppler. Variations in the settings for gain did not interfere significantly in the documentation of regurgitation. Inter-observer variations were not significant (two independent operators). The clinical implications of these findings are yet to be established. Labeling these regurgitant jets as “normal” may be oversimplifying their meaning and perhaps overlooking the possibility of predisposition to endocarditis or progression of the valvar abnormality. Conversely, labeling them as “abnormal” can generate a more serious problem, which is that of iatrogenic heart disease. Prospective follow-up studies should be carried out in these subjects.

Keywords

Echocardiographynormal childrenvalvar regurgitation
Type
Original Articles
Information
Cardiology in the Young , Volume 2 , Issue 3 , July 1992 , pp. 291 - 297
Copyright
Copyright © Cambridge University Press 1992

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Quiñones, MA, Young, JB, Waggoner, AD, Ostojic, MC, Ribeiro, LGT, Miller, RR. Assessment of pulsed Doppler echocardiography in the detection and quantification of aortic and mitral regurgitation. Br Heart J 1980; 44: 612–619.CrossRefGoogle ScholarPubMed
2. Miyatake, K, Okamoto, M, Kinoshita, N, Matsuhisa, M, Nagata, S, Beppu, S, Park, Y, Sakakibara, H, Nimura, Y. Pulmonary regurgitation studied with the ultrasonic Doppler technique. Circulation 1982; 66: 777–786.CrossRefGoogle Scholar
3. Veyrat, C, Kalmanson, D, Farjon, M, Manin, JP, Abitabol, G. Non-invasive diagnosis and assessment of tricuspid regurgitation and stenosis using one and two dimensional echo-pulsed Doppler. Br Heart J 1982; 47: 596–605.CrossRefGoogle ScholarPubMed
4. Omoto, R, Yokote, Y, Takamoto, S, Kyo, S, Euda, K, Asano, H, Namekawa, K, Kasai, C, Kondo, Y, Koyano, A. The development of real-time two-dimensional Doppler echocardiography and its clinical significance in acquired heart diseases with special reference to the evaluation of valvular regurgitation. Jpn Heart J 1986; 25: 325–337.CrossRefGoogle Scholar
5. Miyatake, K, Izumi, S, Okamoto, M, Kinoshita, N, Asonuma, H, Nakagawa, H, Yamamoto, K, Takamiya, M, Sakakibara, H, Nimura, Y. Semiquantitative grading of severity of mitral regurgitation by real-time two-dimensional Doppler flow imaging technique. J Am Coll Cardiol 1986; 7: 82–89.CrossRefGoogle ScholarPubMed
6. Helmcke, F, Nanda, NC, Hsiung, MC, Soto, B, Adey, CK, Goyal, RG, Gatewood, RP. Color Doppler assessment of mitral regurgitation with orthogonal planes. Circulation 1987; 75: 175–183.CrossRefGoogle ScholarPubMed
7. Yock, PG, Naasz, C, Schnittger, I, Popp, RL. Doppler tricuspid regurgitation in normals: is it real? Circulation 1984; 70 (Suppl II): II 40. [ Abstract ]Google Scholar
8. Kosrucki, W, Vandenbossche, J, Friart, A, Englert, M. Pulsed Doppler regurgitant flow patterns of normal valves. Am J Cardiol 1986; 58: 309–315.CrossRefGoogle Scholar
9. Recusani, F, Valdés-Cruz, LM, Dalton, N, Sahn, DJ, Hoit, B. Detection of coronary flow by pulsed Doppler and color Doppler flow mapping and its differentiation from pulmonary insufficiency. J Am Col Cardiol 1986; 7: 14A.Google Scholar
10. Akasaka, Y, Yoshikawa, J, Yoshida, K, Okumachi, F, Koizumi, K, Shiratori, K, Takao, S, Shakudo, M, Kato, H. Age-related valvular regurgitation: a study by pulsed-Doppler echocardiography. Circulation 1986; 76: 262–269.CrossRefGoogle Scholar
11. Abbasi, AS, Allen, MW, Descristofaro, D, Ungar, I. Detection and estimation of the degree of mitral regurgitation by range-gated pulsed Doppler echocardiography. Circulation 1988; 61: 143–151.CrossRefGoogle Scholar
12. Waggoner, AD, Quinones, MA, Young, JB, Brandon, TA, Shah, AA, Verani, MS, Miller, RR. Pulsed Doppler echocardiographic detection of right-sided valve regurgitation. Am J Cardiol 1981; 47: 279–287.CrossRefGoogle ScholarPubMed
13. Pollak, SJ, McMillan, SA, Knopff, WD, Wharff, R, Yoganathan, AP, Felner, JM. Cardiac evaluation ofwomen distance runners by echocardiographic color Doppler flow mapping. J Am Col Cardiol 1988; 11:89–97.CrossRefGoogle Scholar
14. Choong, YC, Chir, MBB, Abascal, VM, Weyman, J, Levine, RA, Gentile, F, Thomas, JD, Weyman, AE. Prevalence of valvular regurgitation by Doppler echocardiography in patients with structurally normal hearts by two-dimensional echocardiography. Am Heart J 1989; 117: 636–645.CrossRefGoogle ScholarPubMed
15. Takao, S, Miyatake, K, Izumi, S, Okamoto, M, Kinoshita, HN, Yamamoto, K, Sakakibara, H, Nimura, Y. Clinical implications of pulmonary regurgitation in healthy individuals: detection by cross-sectional pulsed Doppler echocardiography. Br Heart J 1988; 59: 542–551.CrossRefGoogle ScholarPubMed
16. Yoshida, K, Yoshikawa, J, Shakudo, M, Akasaka, T, Jyo, Y, Takao, S, Shiratori, K, Koizumi, K, Okumachi, F, Kato, H, Fukaya, T. Color Doppler evaluation of valvular regurgitation in normal subjects. Circulation 1988; 78: 840–848.CrossRefGoogle ScholarPubMed
17. Sahn, DJ, Maciel, BC. Physiological valvular heart disease: Doppler echocardiography and the potential for iatrogenic heart disease. Circulation 1988; 78: 1075–1083.CrossRefGoogle ScholarPubMed
18. Recusani, F, Valdes-Cruz, L, Dalton, N, Hoit, B, Sahn, DJ, Swensson, R. Tricuspid and pulmonary insufficiency and right heart flow patterns in normals: studies using color coded flow mapping and pulsed Doppler. Circulation 1985; 72 (Suppl III): III 372. [ Abstract ]Google Scholar