title: A comprehensive echocardiographic protocol for assessing neonatal right ventricular dimensions and function in the transitional period: normative data and z scores.
abstract: BACKGROUND
  There is a paucity of echocardiographic data describing right ventricular (RV) dimensions and function in the early transitional newborn period.
  
  
  METHODS
  Fifty healthy term newborns underwent serial echocardiography at a mean of 15 ± 2 and 35 ± 2 hours of age. RV dimensions and functional indices were measured as recommended in the American Society of Echocardiography's recent guidelines. Additional novel parameters included RV anteroinferior basal diameter, fractional area change (FAC) from the apical three-chamber view, and speckle-tracking echocardiography-derived peak longitudinal strain in the RV lateral (apical four-chamber view) and inferior (apical three-chamber view) walls. Results obtained at both time points were compared.
  
  
  RESULTS
  Linear dimensions and tissue Doppler velocities were highly reproducible, while time intervals and FAC measurements were more variable. Three-chamber FAC was higher than four-chamber FAC (36 ± 5% vs. 24 ± 7%, P < .001). Lateral wall peak longitudinal strain was similar to the value for the inferior wall (22 ± 4% vs 18 ± 5%, P > .05). A small increase in RV dimensions was noted on day 2 of life (midcavity diameter, 1.71 ± 0.19 vs 1.55 ± 0.19 cm, P < .01; RV anteroinferior basal diameter, 2.24 ± 0.29 vs 2.06 ± 0.24 cm, P < .01; end-diastolic-area in the apical four-chamber view, 4.32 ± 0.64 vs 4.10 ± 0.69 cm(2), P = .04), while no changes occurred in functional indices. RV dimensions and FAC showed moderate linear correlations with birth weight. Z scores could be computed for the majority of measured indices.
  
  
  CONCLUSIONS
  Using conventional and novel indices, the investigators describe a comprehensive echocardiographic protocol for neonatal RV imaging, establish reference ranges, and describe the effect of physiologic postnatal transition on RV dimensions and function. This will facilitate future investigations of RV dysfunction in neonatal cardiopulmonary disorders.
authors.affiliation: Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada. Electronic address: ajain@mtsinai.on.ca.
authors.forename: Amish
authors.initials: A
authors.lastname: Jain
authors.affiliation: Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
authors.forename: Adel
authors.initials: A
authors.lastname: Mohamed
authors.affiliation: Department of Pediatrics, The Rotunda Hospital, Dublin, Ireland.
authors.forename: Afif
authors.initials: A
authors.lastname: El-Khuffash
authors.affiliation: University of Toronto, Toronto, Ontario, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, Toronto, Ontario, Canada.
authors.forename: Kim A
authors.initials: KA
authors.lastname: Connelly
authors.affiliation: The Labatt Family Heart Center, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Frederic
authors.initials: F
authors.lastname: Dallaire
authors.affiliation: University of Toronto, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada; Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, Toronto, Ontario, Canada; Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Jankov
authors.affiliation: University of Toronto, Toronto, Ontario, Canada; Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: McNamara
authors.affiliation: University of Toronto, Toronto, Ontario, Canada; Division of Pediatric Cardiology, Faculty of Medicine, University of Sherbrooke, and Centre de Recherche Clinique Étienne-Le Bel, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Luc
authors.initials: L
authors.lastname: Mertens
mesh_terms: D001724:Birth Weight / Q000502:physiology*; D004452:Echocardiography / Q000379:methods*; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D007231:Infant, Newborn; D008297:Male; D012016:Reference Values; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume / Q000502:physiology*; D016276:Ventricular Function / Q000502:physiology*
keywords: Echocardiography; Neonate; Right ventricle; Speckle-tracking