Usefulness of Doppler tissue imaging analysis of tricuspid annular motion for determination of right ventricular function in normal infants and children

Quantitation of right ventricular (RV) function has been difficult to assess noninvasively secondary to its nongeometric shape and respiratory-variable filling. Reports have described the pattern of RV filling across the tricuspid valve in diastole using Doppler echocardiography in infants with normal cardiac anatomy(1) and in children with congenital heart disease.(2) The utility of this technique, however, has been limited by significant variation in the patterns of filling during respiration, which appear more related to changes in intrathoracic pressure/systemic venous return rather than alterations in the intrinsic diastolic properties of the right ventricle. In a similar way, no adequate RV geometric model has been developed to allow simple volume analysis or calculation of ejection fraction using echocardiography. Because RV systolic and diastolic dysfunction likely play a significant role in morbidity and mortality in many patients with congenital heart disease, a noninvasive technique that would allow assessment of RV function would be valuable. Recent developments in ultrasound technology now allow display of instantaneous changes in myocardial velocities, which has been called Doppler tissue imaging (DTI). This new technique allows characterization of myocardial and atrioventricular valve annular motion velocities throughout the cardiac cycle. Application of this technique in the analysis of mitral annular and left ventricular motion has provided additional insight into the noninvasive assessment of left ventricular diastolic function.(3-15) This technique has also been applied to the assessment of RV myocardial motion in adults, 16 but has not been described in children. This report summarizes our experience in the use of pulsed DTI in assessing tricuspid annular motion in a cohort of normal infants and children.