Management of many congenital heart diseases (CHD) depends on right ventricle (RV) assessment for which cardiac magnetic resonance (CMR) remains the gold standard. The objective of this study was to assess feasibility and reproducibility of a new semi-automated algorithm to quantify RV (4D auto RVQ) from 3D transthoracic echocardiography (3D TTE) in a pediatric population, and to compare measurements with those obtained from CMR.

In all, 90 infants were prospectively included (age 7.5 years, 3–18). Fifteen healthy infants and 75 patients with CHD (30 repaired TOF, 25 ASD, 8 dilated pulmonary valve stenosis, 7 tricuspid regurgitation, 3 APVR, and 2 repaired TAC). All patients underwent 2D and 3D TTE (Vivid E95, GE Healthcare). RV end-diastolic volume (RVEDV), RV end-systolic volume (RVESV), RV ejection volume (RVEV) and RV ejection fraction (RVEF) were analyzed by 4D auto RVQ and compared with measurements from 18 patients who underwent CMR exams for the follow up of their cardiopathy.

4D auto RVQ was feasible in 87 infants (96.7%). In 3 patients 4D auto RVQ was unable to detect RV contouring due to inadequate image quality. Manual contour adjustment was necessary in 81 cases (80%). Mean time of analysis including the time of manual adjustment was 62seconds. RV was enlarged in 65 of 75 patients with CHD (mean 95ml/m², 62–165ml/m²). Good correlation for RVEDV, RVESV, RVEV and RVEF was found between 4D auto RVQ and CMR (r=0.89–0.99, all P<0.0001). 4D auto RVQ underestimated RVEDV/BSA of 8ml/m² and RVEF by 6%, and overestimated RVESV/BSA of 9ml/m². Intraobserver and interobserver variability were low (4.7% and 8.9% respectively) (Fig. 1).

4D auto RVQ is a promising tool for assessment of RV volume and function in children. Such simple and non-invasive exam could reduce the practice of CMR imaging during the follow up of children with CHD.