Echocardiographic assessment of right ventricular function status in children with congenital heart disease with irreversible and reversible pulmonary hypertension compared to normal children


  • M. Tariqul Islam Department of Pediatric Cardiology, BSMMU, Shahbag, Dhaka, Bangladesh
  • Hira Nand Yadav Department of Pediatric Cardiology, BSMMU, Shahbag, Dhaka, Bangladesh
  • Tahmina Karim Department of Pediatric Cardiology, BSMMU, Shahbag, Dhaka, Bangladesh
  • Mohammad S. Alam Department of Pediatric Cardiology, BSMMU, Shahbag, Dhaka, Bangladesh
  • Chaity Barua Department of Pediatric Cardiology, BSMMU, Shahbag, Dhaka, Bangladesh



RV function in children, Pulmonary hypertension, Transthoracic echocardiography


Background: Right ventricular (RV) dysfunction is prevalent in children with congenital heart disease (CHD), particularly in association with pulmonary hypertension (PH). Transthoracic echocardiography (TTE) is crucial for detecting, assessing severity, and monitoring CHD patients with PH. The current study aimed to compare RV function assessed by TTE between CHD patients with PH and healthy children.

Methods: The case group comprised CHD patients diagnosed with PH via TTE and confirmed by cardiac catheterization. The control group included children with normal echocardiograms. A total of 40 patients were enrolled based on predefined criteria.

Results: The study included 20 cases and 20 controls. Echocardiographic parameters revealed significant differences between the case and control groups, with increased RV dimensions in the case group, except for RV subcostal wall thickness. RV systolic function parameters, including tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (S'), were significantly lower in the case group. RV diastolic function parameters, including E/A ratio, E/e', and deceleration time (DT), were also significantly different between the groups. The RV global function parameter, tissue Doppler imaging-derived myocardial performance index (TD MPI), was significantly higher in the case group.

Conclusions: Echocardiographic evaluation of RV function, including TAPSE, S', TD MPI, E/A ratio, E/e', and DT, in CHD children with PH correlates with PH severity. This assessment can aid in early detection of PH severity before irreversible changes occur and serve as an alternative to right heart catheterization.


Simonneau G, Montani D, Celermajer DS, Denton CP, Gatzoulis MA, Krowka M, et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Resp J. 2019;53:1-13.

Dimopoulos K, Condliffe R, Tulloh RM, Clift P, Alonso-Gonzalez R, Bedair R, et al. Echocardiographic screening for pulmonary hypertension in congenital heart disease: JACC review topic of the week. J Am Coll Cardiol. 2018;72(22):2778-88.

Vijayalakshmi IB, Rao PS, Chugh R. A comprehensive approach to congenital heart disease. 2nd Edition. Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India. 2013.

Lai WW, Mertens LL, Cohen MS, Geva T. Echocardiography in Pediatric and Congenital Heart Disease, from fetus to Adult. 2nd Edition. Wiley. 2016.

Chen EP, Craig DM, Bittner HB, Davis RD, Van Trigt P. Pharmacological strategies for improving diastolic dysfunction in the setting of chronic pulmonary hypertension. Circulation. 1998;97:1606-12.

Taylor BJ, Shapiro BP, Johnson BD. Exercise intolerance in heart failure: The important role of pulmonary hypertension. Exp Physiol. 2020;105(12):1997-2003.

Moscucci M. Grossman and Baim’s Cardiac Catheterization, Angiography and Intervention. 8th Edition. Wolters Kluwer. 2014.

Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for theechocardiographic assessment of the right heart inadults: A report from the American Society of Echocardiography. J Am Soc Echocardiogr. 2010;23:685-713.

Cevik BS, Cevik A, Tavli E. Second degree heart block associated with QT prolongation. Indian Pacing Electrophysiol J. 2010;10(2):96.

Friesen RM, Schäfer M, Burkett DA, Cassidy CJ, Ivy DD, Jone PN. Right Ventricular Tissue Doppler Myocardial Performance Index in children with pulmonary hypertension: relation to invasive hemodynamics. Pediatric Cardiol. 2018;39:98-104.

Forfia PR, Fisher MR, Mathai SC, Housten-Harris T, Hemnes AR, Borlaug BA, et al. Tricuspid annular displacement predicts survival in pulmonary hypertension. Am J Resp Crit Care Med. 2006;174(9):1034-41.

Okumura K, Slorach C, Mroczek D, Dragulescu A, Mertens L, Redington AN, et al. Right ventricular diastolic performance in children with pulmonary arterial hypertension associated with congenital heart disease: correlation of echocardiographic parameters with invasive reference standards by high-fidelity micromanometer catheter. Circulation. 2014;7(3):491-501.

Cabrita IZ, Ruisanchez C, Dawson D, Grapsa J, North B, Howard LS, et al. Right ventricular function in patients with pulmonary hypertension; the value of myocardial performance index measured by tissue Doppler imaging. Eur J Echocardiogr. 2010;11:719-24.






Original Research Articles