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Abstract
Summary and conclusion Assessment of the pulmonary artery pressure in an important item in the diagnosis of cases of congenital heart disease , with left to right shunts. The presence of pulmonary hypertension and pulmonary vascular resistance is the primary impediment to a successful surgical outcome.
In this work, we studied 30 cases of congenital heart disease with left to right shunts. They classified into three groups:
• Group I included 9 patients with VSD.
• Group II included 5 patients with ASD.
• Group III included 16 patients with companied lesions (two or three of the following VSD, ASD, and PAD).
PASP was assessed by echocardiography using peak velocity of tricuspid regurgitation jet.Full hemodynamic study, including pulmonary artery pressure, Qp/Qs and pulmonary to systemic vascular resistance ratio was performed.
Statistical analysis of the results revealed no significant difference between the two methods of measurement of PASP . Also, significant positive correlation was found between PASP obtained by Doppler echocardiography through tricuspid regurgitation jet and PASP obtained during cardiac catheterization.
There was no significant difference between the two methods of measurement of PASP in syndromatic and non syndromatic patients. Also, there was no significant difference between the two methods in patients with and patients without precordial pulge.
It means that neither syndromatic case nor precordial pulge affect the accuracy of Doppler echocardiography in measurement of PASP, as long as, the peak velocity of regurgitant jet can be measured.
There were significant decreases in PASP and Rp/Rs after administration of oxygen in cases with elevated PASP and Rp/Rs.
Also, there were positive relation between impairment of weight gain , dyspnea and exertional cyanosis, and PASP.
from this study, we concluded that echocardiography is an accurate , noninvasive method in measurement of pulmonary artery pressure in congenital heart disease with left to right shunts.
Recommendations. 1. Echocardiographic measurement of PASP, through tricuspid regurgitation, is fairly accurate, non-invasive method in congenital heart disease with left to right shunt. 2. Cardiac catheterization still the standard tool for estimation of pulmonary artery pressure. 3. Reactivity of pulmonary vascular bed must be assessed before diagnosis of irreversible PH.