Original Article Echocardiography in the Assessment of Left Atrial Pressure After Pediatric Heart Surgery: A Comparison Study With Measurements Obtained From Left Atrial Catheter Marc Figueras-Coll, MD 1 , Joan Sanchez-de-Toledo, MD, PhD 2,3 , Ferran Gran, MD 1 , Raul Abella, MD 4 , Santiago Perez-Hoyos 5 , and Ferran Rose ´s, MD 1 Abstract Background: Correlation between ventricular end-diastolic pressure and pulsed Doppler and tissue Doppler–derived E/e’ ratio has been widely reported in adults but scarcely studied in children with congenital heart diseases. This ratio is defined as the relationship between diastolic transmitral flow velocity (cm/s; E) and myocardial diastolic relaxation velocity (cm/s; e’) in the lateral aspect of the mitral annulus. Our main objective was to ascertain whether a correlation existed between direct mea- surement of left atrial pressure and echocardiographic E/e’ ratio in children after heart surgery. Methods: Prospective study including 27 consecutive children after pediatric heart surgery. Data were analyzed according to whether they were obtained within the first 72 hours following surgery or later on. Sensitivity, specificity, positive and negative predictive values, and areas under the receiver–operating characteristics curve of E/e’ ratio in detection of left atrial pressure values 13 mm Hg were evaluated. Results: Forty-eight studies were conducted in 27 patients. Thirty-two studies were performed during the first 72 hours after heart surgery and 16 beyond the third day. Median patient age was 0.82 years (5 days-16 years). Median left atrial pressure values and E/e’ measurements of the whole cohort (N ¼ 48) were 12.0 and 10.2, respectively. Intraclass correlation index between left atrial pressure values and echocardiographic E/e’ ratio was 0.35, 0.25 for studies performed within 72 hours, but 0.78 (P < .01) for those performed later. There was also a high positive predictive value, since in 13 (87%) of 15 studies with an E/e’ ratio 13, the left atrial pressure was 13 mm Hg. Conclusion: While echocardiographic E/e’ ratio did not show a good correlation with left atrial pressure in the immediate postoperative period, the positive predictive value may suffice to aid clinicians in predicting elevated pressures. Keywords echocardiography, atrium, congenital heart surgery, pediatric Submitted February 28, 2015; Accepted May 13, 2015. Introduction Left atrial pressure reflects left ventricle preload and, indir- ectly, diastolic function. In the immediate postoperative period following heart surgery, left atrial pressure measurement can provide important information on the dynamics of the left heart. Elevated left atrial pressure can be secondary to cardiac dysfunction (systolic and diastolic), volume overload, or surgi- cal residual defects. 1 Direct measurement of left atrial pressure requires intrathoracic catheter placement and can be associated with greater morbidity, since it can be a source of sepsis, embolic events, or local hemorrhagic complication. 2,3 Nonin- vasive estimation of left atrial pressure could facilitate the man- agement of these patients after heart surgery. 1 Department of Pediatric Cardiology, Hospital Universitari Vall d’Hebron, Universitat Auto ` noma de Barcelona, Barcelona, Spain 2 Cardiac Intensive Care Unit, Hospital Universitari Vall d’Hebron, Universitat Auto ` noma de Barcelona, Barcelona, Spain 3 Department of Critical Care Medicine, Division Cardiac Intensive Care, Children’s Hospital of Pittsburgh, University of Pittsburgh, PA, USA 4 Department of Pediatric Cardiothoracic Surgery, Hospital Universitari Vall d’Hebron, Universitat Auto ` noma de Barcelona, Barcelona, Spain 5 Unit of Clinical Research Support, Vall d’Hebron Research Institut, Universitat Auto ` noma de Barcelona, Barcelona, Spain Corresponding Author: Marc Figueras-Coll, Pediatric Cardiology Unit, Department of Pediatric Medicine, Hospital Universitari Vall d’Hebron, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain. Email: mfiguerascoll@gmail.com World Journal for Pediatric and Congenital Heart Surgery 2015, Vol. 6(3) 438-442 ª The Author(s) 2015 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/2150135115589999 pch.sagepub.com by guest on July 16, 2015 pch.sagepub.com Downloaded from