Giordano et al reported an echocardiographic score for predicting if a patient will be dependent on a patent ductus arteriosus following surgery for congenital pulmonary valve stenosis or atresia. The authors are from Ospedali del Colli in Naples and Heart Hospital G. Pasquinucci in Massa, Italy.
PDDPC = persistent duct-dependency of the pulmonary circulation
Patient selection: congenital pulmonary atresia or stenosis
Parameters:
(1) z-score for tricuspid valve annulus diameter
(2) tricuspid to mitral valve ratio
(3) z-score for pulmonary valve diameter
(4) end-diastolic right ventricular area in square cm
(5) end-diastolic right atrial area in square cm
(6) percent interatrial right to left shunt
(7) tricuspid regurgitation
(8) right ventricular systolic pressure in mm Hg
(9) E/E' ratio
|
Parameter
|
Finding
|
Points
|
|
z score for TV annulus diameter
|
< -2.12
|
1
|
|
|
>= 2.12
|
0
|
|
TV to MV annular ratio
|
< 0.78
|
1
|
|
|
>= 0.78
|
0
|
|
z-score for PV annulus diameter
|
< -1.17
|
1
|
|
|
>= -1.17
|
0
|
|
RV end-diastolic area
|
< 1.35
|
1
|
|
|
>= 1.35
|
0
|
|
RA end-systolic area
|
<= 2.45
|
0
|
|
|
> 2.45
|
1
|
|
interatrial right to left shunt
|
<= 69.5%
|
0
|
|
|
> 69.5%
|
1
|
|
tricuspid regurgitation
|
none or mild
|
0
|
|
|
moderate or severe
|
1
|
|
RV systolic pressure
|
<= 42.5
|
0
|
|
|
> 42.5
|
1
|
|
E/E' ratio
|
<= 6.6
|
0
|
|
|
> 6.6
|
1
|
total score =
= SUM(points for all parameters)
Interpretation:
• minimum score: 0
• maximum score: 9
• A score >= 4 indicates to need for pulmonary blood flow support.
• A score >= 6 was associated with duct dependency.
• A score <=3 is associated with an additional pulmonary blood flow source.
Performance:
• The area under the ROC curve was 0.98.
