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Prevalence of valvar regurgitation by color Doppler echocardiography in neonates with normal hearts

Published online by Cambridge University Press:  19 August 2008

Zhong-Dong Du ,
Nathan Roguin ,
Mila Barak  and
Elliot Milgram
Zhong-Dong Du
Affiliation:
Heart Institute and Department of Neonatology, Western Galilee Hospital-Nahariya, Technion Faculty of Medicine, Nahariya
Nathan Roguin*
Affiliation:
Heart Institute and Department of Neonatology, Western Galilee Hospital-Nahariya, Technion Faculty of Medicine, Nahariya
Mila Barak
Affiliation:
Heart Institute and Department of Neonatology, Western Galilee Hospital-Nahariya, Technion Faculty of Medicine, Nahariya
Elliot Milgram
Affiliation:
Heart Institute and Department of Neonatology, Western Galilee Hospital-Nahariya, Technion Faculty of Medicine, Nahariya
*
Dr. Nathan Roguin, Heart Institute, Western Galilee Hospital-Nahariya, P.O Box 21, 22100 Nahariya, Israel. Tel. 972-4-985-0747; Fax. 972-4-985-0530.
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Abstract

Valvar regurgitation has been commonly found by echocardiography in adults and older children with normal hearts, but there is limited knowledge in neonates. To evaluate the prevalence of valvar regurgitation and analyze risk factors, echocardiography was performed on 975 consecutive neonates (1–7 days of age) with normal hearts. Regurgitation was detected and graded with pulsed, continuous-wave and color Doppler imaging techniques. Thirty-five cases with valvar regurgitation were followed for one month. The results showed that 369 (37.8%) neonates had evidence of regurgitation in one or more valves. Tricuspid regurgitation was most commonly found and was detected in 345 (35.4%) neonates, mitral regurgitation in 51 (5.2%), pulmonic regurgitation in 25 (2.6%), and aortic regurgitation in eight (0.8%). Most of them were trivial or mild and involved just one valve. Moderate or severe regurgitation was detected only in the tricuspid valve (3%) and the mitral valve (0.1 %). Five (0.5%) neonates with severe tricuspid regurgitation had heart murmurs, and two (0.2%) of them presented with cardiorespiratory distress. The risk factors for tricuspid and mitral regurgitation included lower chronologic age, gestational age and whether the neonates had a patent arterial duct; whereas those for tricuspid regurgitation also related to lower Apgar scores, birth weight and whether the neonates had a patent oval foramen. About 90% of the tricuspid regurgitation disappeared and the remaining 10% decreased in one month. We concluded that trivial or mild valvar regurgitation is commonly found in neonates with normal hearts. Moderate or severe regurgitation is relatively rare and occurs only in the tricuspid and mitral valves with a few cases causing clinical attention.

Keywords

Valvar regurgitationDoppler echocardiographyneonate
Type
Original Manuscripts
Information
Cardiology in the Young , Volume 6 , Issue 3 , July 1996 , pp. 216 - 221
Copyright
Copyright © Cambridge University Press 1996

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References

1.Sahn, DJ, Maciel, BC. Physiological valvular regurgitation: Doppler echocardiography and the potential for iatrogenic heart disease. Circulation 1985; 78: 1075–1077.CrossRefGoogle Scholar
2.Waggoner, AD, Quinones, MA, Young, JB, Brandon, TA, Shah, AA, Yerani, MS, Miller, RR. Pulsed Doppler echocardiographic detection of right-sided valve regurgitation: experimental results and clinical significance. Am J Cardiol 1981; 47: 279–286.CrossRefGoogle ScholarPubMed
3.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
4.Patel, AK, Rowe, GC, Dhanani, SP, Kosolcharoen, P, Lyle, LEW, Thomsen, JH. Pulsed Doppler echocardiography in diagnosis of pulmonary regurgitation: its value and limitations. Am J Cardiol 1982; 49: 1801–1805.CrossRefGoogle Scholar
5.Kostucki, W, Vandenbossche, J, Englert, M. Pulsed Doppler regurgitant flow patterns of normal valves. Am J Cardiol 1986; 58: 309–313.CrossRefGoogle ScholarPubMed
6.Yoshida, K, Yoshikawa, J, Shakudo, M, Okumachi, K, Kato, M, Fukaya, T. Color Doppler evaluation of valvular regurgitation in normal subjects. Circulation 1988; 78: 840–847.CrossRefGoogle ScholarPubMed
7.Berger, M, Hecht, SR, Van Tosh, A, Lingam, U. Pulsed and continuous wave Doppler echocardiographic assessment of valvular regurgitation in normal subjects. J Am Coll Cardiol 1989; 13: 1540–1545.CrossRefGoogle ScholarPubMed
8.Akasaka, T, Yoshikawa, J, Yoshida, K, Okumachi, F, Koizumi, K, Shiratori, K, Takao, S, Shakudo, M, Kato, H. Age-related valvular regurgitation: a study by Doppler echocardiography. Circulation 1987; 76: 262–265.CrossRefGoogle ScholarPubMed
9.Brand, A, Dollberg, S, Keren, A. The prevalence of valvular regurgitation in children with structurally normal hearts: a color Doppler echocardiographic study. Am Heart J 1992; 123: 177–180.CrossRefGoogle ScholarPubMed
10.Skinner, JR, Boys, RJ, Hunter, S, Hey, EN. Non-invasive assessment of the pulmonary arterial pressure in healthy neonates. Arch Dis Child 1991; 66: 386–390.CrossRefGoogle ScholarPubMed
11.Senocak, F, Ozkutlu, S. Neonatal tricuspid insufficiency—a Doppler echocardiographic study of 49 cases. Cardiol Young 1995; 5: 172–175.CrossRefGoogle Scholar
12.Kelley, JR.Guntheroth, WG. Pansystolic murmur in the new born: tricuspid regurgitation versus ventricular septal defect. Arch Dis Child 1988; 63: 1172–1174.CrossRefGoogle Scholar
13.Gewillig, M, Dumoulin, M, Van der Hauwaert, LG. Transient neonatal tricuspid regurgitation: a Doppler echocardiographic study of three cases. Br Heart J 1988; 60: 446–451.CrossRefGoogle ScholarPubMed
14.Berman, W, Whitman, V, Stanger, P, Rudolph, AM.Congenital tricuspid incompetence simulating pulmonary atresia with intact ventricular septum, a report of two cases. Am Heart J 1978; 96: 655–661.CrossRefGoogle ScholarPubMed
15.Roguin, N, Du, Z-D, Barak, M, Nasser, N, Hershkowitz, S, Milgram, E. The high prevalence of muscular ventricular septal defect in neonates. J Am Coll Cardiol 1995; 26: 1545–1548.CrossRefGoogle ScholarPubMed
16.Choong, CY, 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: 636–642.CrossRefGoogle ScholarPubMed
17.Snider, AR,. Two-dimensional and echocardiographic evaluation of heart disease in the neonate and fetus.In:Hustreiter AR(ed). Clinics in Perinatology. W.B.Saunders Company Philadelphia 1988 523–565.Google Scholar
18.Evens, N, Iyer, P. Incompetence of the foramen ovale in preterm infants supported by mechanical ventilation. J Pediatr 1994; 125:786–792.CrossRefGoogle Scholar
19.Bucciarelli, RL, Nelson, RM, Egan, EA, Eitzman, DV, Gessner, IH. Transient tricuspid insufficiency of the newborn: A form of myocardial dysfunction in stressed newborns. Pediatrics 1977; 59: 330–337.CrossRefGoogle Scholar
20.Berry, TE, Muster, AJ, Paul, MH. Transient neonatal tricuspid regurgitation: possible relation with premature closure of the ductus arteriosus. J Am Coll Cardiol 1983; 2: 1178–1182.CrossRefGoogle ScholarPubMed
21.Carter, BS, Haverkamp, AD, Merensteiin, GB. The definition of acute perinatal asphyxia. Clinics in Perinatology 1993; 20: 287–304.CrossRefGoogle ScholarPubMed
22.Baylen, BG, Gleason, MM, Waldhansen, JA. Congenital mitral insufficiency. In: Emmanouilides, GC, Allen, HD, Riemen-schneider, TA, Gutgescell, HP (eds). Moss and Adams' Heart Disease in Infants, Children, and Adolescents, including theFetus and Young Adults. Fifth edition. Williams & Wilkins, Baltimore, 1995, pp 1055–1063.Google Scholar