The influence of loud crying on pulmonary gradients obtained by transthoracic echocardiography in children with pulmonary valve stenosis

INTRODUCTION: Pulmonary valve stenosis (PS) is the obstruction of blood outflow from the right ventricle of the heart at the level of the pulmonary valve. Crying is associate with an increase in venous return and it has been known to have some acute effects on cardiovascular system, the data about the alterations in echocardiographic findings during crying is limited. To explore the influences of loud crying in evaluation of transvalvular gradient obtained by Doppler echocardiography in children with pulmonary valve stenosis (PS).
METHODS: Our study group included a total of 48 children, aged between 2 and 43 months who were diagnosed with pulmonary valve stenosis based on the clinical signs and laboratory (Echocardiography) findings in our hospital. We compared the pulmonary gradients obtained by echocardiography while the children were crying and while they were calm.
RESULTS: Totally 48 patients (23 male, 25 female) diagnosed with PS in our hospital were included in the study. The mean age of the patients was 19.27±11.14 months (range: 2-43 months). During crying, both maximum and mean pulmonary gradients were statistically significantly higher compared with the results obtained while the patients were calm (p<0.001, p =0.001, respectively).
DISCUSSION AND CONCLUSION: In conclusion, significant increases in both maximum and mean pulmonary gradients were determined during loud crying. Since these parameters are the main determinants of management of patients with PS, this condition should be kept in mind and if possible these measurements should be obtained while the children are in a calm state. Larger prospective studies are warranted to support our findings.