Determination of Vena Contracta Reference Values in Children with Physiologic Tricuspid Valve Insufficiency

Abstract

Objective: Physiologic tricuspid valve insufficiency is a common echocardiographic finding in healthy children. However, there is limited data on its echocardiographic characteristics in childhood. Vena contracta (VC) is defined as the narrowest part of the regurgitant insufficiency jet, which is measured by color Doppler echocardiography just distal to the regurgitant orifice. It is usually preferred because of its simplicity in measuring in clinical practice and sensitivity in revealing the severity of valve insufficiency. However, due to the growing nature of pediatric population, it is difficult to report exact values of vena contracta to distinguish between pathologic and physiologic tricuspid valve insufficiency. The aim of this study is to determine if there is a relationship between anthropometric measurements and vena contracta diameter. Additionally, the study aims to calculate reference values for vena contracta in healthy Turkish children with tricuspid valve insufficiency.

Methods: A total of 487 children between the ages of 0 and 18 years, who were admitted to the pediatric cardiology clinic and had normal echocardiographic evaluations, were included in the study. Measurements of VC and tricuspid valve regurgitation jet length were obtained using color Doppler echocardiography, while the velocity of the tricuspid valve was measured using continuous wave Doppler echocardiography. The vena contracta width of the tricuspid regurgitation was typically visualized in the apical four-chamber view using optimal settings to obtain the best image quality.

Results: The mean VC in the study group was 2.77 ± 0.7 mm, and there was no significant difference between genders in terms of VC value. There was a statistically significant positive correlation between age and body surface area and VC value. In addition, there was a significant positive correlation between VC and echocardiographically measured insufficiency jet length and velocity.

Conclusion: The present study offers reference values and z-scores for VC measurement in tricuspid valve insufficiency in healthy Turkish children. This fills the existing gap in knowledge and enhances the clinical utility in distinguishing between pathological valve insufficiency.

Keywords: physiological, tricuspid valve insuffiency, healthy children, vena contracta, z score