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Pediatr Cardiol 21:416–421, 2000 DOI: 10.1007/s002460010100

Pediatric Cardiology
© Springer-Verlag New York Inc. 2000

Quantitation of the Global Right Ventricular Function in Children with Normal Heart and Congenital Heart Disease: A Right Ventricular Myocardial Performance Index
M. Ishii,1 G. Eto,1 C. Tei,2 T. Tsutsumi,1 K. Hashino,1 Y. Sugahara,1 W. Himeno,1 H. Muta,1 J. Furui,1 T.Akagi,1 R. Fukiyama,3 O. Toyoda,4 H. Kato1
1 Department of Pediatrics, Kurume University School of Medicine, The Cardiovascular Research Institute, Kurume University, 67 Asahi-machi, Kurume 830, Japan 2 3 4

First Department of Medicine, Kagoshima University School of Medicine, Kagosima, Japan Department of Pediatrics, Iki Public Hospital, Iki, Japan Department of Pediatrics, Omuta City GeneralHospital, Omuta, Japan

Abstract. Although the assessment of right ventricular (RV) function is important in the clinical management of children with congenital heart disease, available imaging techniques have been limited because of the complex geometry of the right ventricle. A new Doppler index combining systolic and diastolic time intervals (the Tei index) has been reported to be useful for theassessment of global RV function in adults. However, normal values in children, age-related changes, and the clinical utility of the Tei index with regard to congenital heart disease have not been demonstrated. The purpose of this study was to prospectively assess RV function in children with normal heart and congenital heart disease using the Tei index. The subjects included 150 healthy childrenand 43 patients with congenital heart disease (35 patients with atrial septal defects and 8 patients who had had a Senning operation). The index was defined as the sum of isovolumetric contraction time and isovolumetric relaxation time divided by ejection time and was measured from conventional RV outflow and inflow Doppler velocity profiles. The Tei index was not affected by age in healthychildren (0.24 ± 0.04). There was a significant difference in index rating between patients who had had a Senning operation (0.58 ± 0.09) and healthy children (p < 0.01), but there was no significant difference between children with atrial septal defect (0.25 ± 0.13) and healthy children. The Tei index is a feasible approach to use when assessing global RV function in children with congential heartdisease. Key words: Right ventricular function — Doppler echocardiography — Senning operation — Atrial septal defect

Correspondence to: M. Ishii

In the clinical management of patients with congenital heart disease (CHD), the evaluation of the global right ventricular (RV) function is of major importance [1, 3, 17]. Although there are many noninvasive and invasive parameters that can be used forthe quantitative assessment of RV function in patients with CHD [9, 10, 15], no parameter has been established for the quantitative assessment of RV function. As they are currently used, these techniques have several limitations when applied to the assessment of RV function, particularly in patients with abnormal RV shape. Most children with CHD have complex geometry of the right ventricle.Recently, an easily measured Doppler index (a right ventricular myocardial performance index that has been named the Tei index) combining systolic and diastolic time intervals has been proposed [24]. The index is applicable to both the right and left ventricles. It is defined as the sum of isovolumetric contraction time and isovolumetric relaxation time divided by ejection time. This index has beenreported to be simple, reproducible, and independent of heart rate, blood pressure, degree of tricuspid regurgitation, and severity of pulmonary hypertension. Recently, this index was reported to correlate well with the severity of congestive heart failure and clinical outcome in adult patients with primary pulmonary hypertension [24, 33]. Because the index is essentially a time ratio [5, 6, 22–25,...