Background and aim .– In congenital heart disease, assessment of right ventricular (RV) function is determinant for patient’s follow-up and therapeutic strategy. However, only few data of RV systolic functioning parameters measured by echocardiography in children are available, and their usual change in different types of RV loading condition. We investigated the feasibility, reproducibility and correlation to 3D RV ejection fraction (RVEF) of each parameter of RV systolic function in children with congenital heart defect affecting the right ventricle.

Methods and results .– We performed echocardiography in 143 consecutive children aged 0 to 18 years with different pathological RV loading condition. We classified them in three groups: dominant volume overload, dominant barometric overload, and mixed overload. We measured RV systolic function parameters described in the pediatric and adult literature: tricuspid annulus posterior systolic excursion (TAPSE), tricuspid annulus maximal systolic velocity in Doppler tissue imaging (Sa), fractional area change (FAC), 2D RVEF, 3D RVEF, isovolumic acceleration (IVA) and Tei index. 3D RVEF was measured using a new system of 2D echography with knowledge-based 3D reconstruction allowing to reconstruct volumes from sections of right ventricle with standard sonographer (Ventripoint, USA). This system has been already validated by MRI volumes measurements.

We found that TAPSE was the most feasible ( n = 137/143; 97.08%), reproducible (ICC = 0.986; P < 0.001) (coefficient of variation = 2.1%) parameter and was significantly correlated to 2D RVEF ( r = 0.301; P = 0.0014) and 3D RVEF ( r = 0.337; P = 0.0014). Z-score TAPSE age-adjusted is significantly different in each type of loading condition (pressure/volume P = 0.0089; mixed/pressure P = 0.365; mixed/volume P = 0.0004). Mixed overload had the worse TAPSE Z-score value (−5) and volume overload had the best TAPSE Z-score value (−1.5). TAPSE is not correlated to RVEF in patients who had previous cardiac surgery with pericardotomy ( P = 0.78).

Conclusion .– We recommend using TAPSE Z-score to assess RV function in children with native CHD. TAPSE cannot be used to assess RV function in children after cardiac surgery with pericardotomy.