Publication Date

2-2026

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Abstract

Background: Single right ventricle and Hypoplastic Left Heart Syndrome (HLHS) are congenital heart diseases that require multiple palliative surgeries to create a single right ventricular system. 25-30% of these patients develop significant tricuspid regurgitation (TR), which is associated with worse outcomes among all stages of palliation. Echocardiography remains the cornerstone imaging modality for serial evaluation in these patients. However, estimating tricuspid regurgitation is highly subjective in the pediatric population, necessitating need for reliable and reproducible quantitative echocardiography markers. Currently, cardiac magnetic resonance (CMR) is considered the gold standard for quantification of tricuspid regurgitation with good accuracy and reproducibility. Objectives/Goal: Our primary aim was to identify quantitative markers of determining TR severity using echocardiography that correlated with CMR between the final two palliative stages. Methods/Design: This was a single-center, retrospective study performed at Children’s Mercy Hospital. Inclusion criteria included patients with single systemic right ventricle with a systemic tricuspid valve who have undergone an echocardiogram within 6 months of their CMR. All other congenital heart diseases were excluded. Patient characteristics included age, sex, body surface area, diagnosis, heart rate with echocardiography and CMR and time between echocardiography and CMR. Multiple echocardiographic variables were recorded including but not limited to Nyquist limit, TR continuous wave doppler density, shape and volume time integral (VTI), vena contract width, jet number, proximal isovelocity surface (PISA) radius, leaflet morphology and right ventricular functional indices. Tricuspid valve regurgitation fraction (TRF) by CMR was recorded and categorized as mild (≤15%) or greater than mild (>15%). Each quantitative echocardiographic variable was correlated with the two groups as estimated by CMR. P value < 0.05 was considered statistically significant. Results: 27 patients met inclusion criteria. Mean age was 3.8 ± 0.7 years. Majority were male (20, 74%) with HLHS being the most common diagnosis (21, 78%). Average heart rate was 89 bpm. Average time between echocardiography and CMR was 31 days (0-112 days). Nyquist limit ranged between 42 to 123 cm/s, with mean of 82.4 cm/s. 20 patients (74%) were characterized as mild based on CMR TRF. Vena contracta width (0.61-0.76 for greater than mild vs 0.17-0.35 for mild, p< 0.001), TR continuous wave VTI (76.8-143.9 for greater than mild vs 15.7-69.3 for mild, p = 0.021) and PISA radius (0.51-0.89 for greater than mild vs 0.21-0.40 for mild, p = 0.006) were statistically significantly higher in the greater than mild category. Calculated indices such as effective regurgitation orifice area and regurgitation volume were statistically significantly higher in greater than mild category (p=0.016 and 0.007, respectively). Conclusions: Although sample size is small, our study highlights echocardiographic markers such as vena contracta width, PISA radius, and associated calculated indices that can potentially be used to better estimate severity of TR in HLHS variants. Future large-scale studies are needed to further evaluate this correlation, which may lead to more objective methods of estimating TR using echocardiography, leading to improved management decisions and outcomes.

Disciplines

Cardiology | Pediatrics

Notes

Presented at the Cardiology 2026: 28th Annual Update on Pediatric and Congenital Cardiovascular Disease; Feb 25-March 1, 2026; Scottsdale, AZ.

Quantitative Echocardiography Markers to Denote Severity of Tricuspid Regurgitation Compared to Cardiac MRI in Single Right Ventricle Variants

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