{"id":5672,"date":"2026-08-21T08:12:13","date_gmt":"2026-08-21T06:12:13","guid":{"rendered":"https:\/\/cvja.co.za\/journal\/?p=5672"},"modified":"2026-08-21T08:12:13","modified_gmt":"2026-08-21T06:12:13","slug":"cvja-2026-033","status":"publish","type":"post","link":"https:\/\/cvja.co.za\/journal\/cvja-2026-033\/","title":{"rendered":"An analysis of imaging modalities to assess the right and left heart in pulmonary hypertension with left-to-right shunts"},"content":{"rendered":"    <div id=\"article\">                                                                                                                        \r\n        <div id=\"title-container\">                                                                                                    \r\n        <div id=\"authors-title\">                                                                                                            \r\n        <!--Aurthors under Title-->                                                                                                            \r\n            \r\nMusawenkosi MF Henema, Stephen C Brown, Francis E Smit, Lezelle Botes\r\n<\/div>        \r\n<\/div>                                                                                                                            \r\n            <div id=\"copyright\">\r\n        <strong>Copyright:<\/strong> Clinics Cardive Publishing (Pty) Ltd. publisher\r\n        of Cardiovascular Journal of Africa.<\/div>\r\n    <div style=\"clear: both;\"><\/div>                                                                                                                                \r\n        <div id=\"article-abstract\">                                                                                                            \r\n            <div id=\"abstract-title\">                                                                                                        \r\n                    Abstract                                                                                                                \r\n                <\/div>                                                                                                                        \r\n                                                                                                                                \r\n            <div id=\"abstract-content\">                                                                                                        \r\n            <!--Content of Abstract Article-->                                                                                                \r\n            <!--<strong>\"Abstract titles\":<\/strong>-->                                                                                        \r\n            <!--<br\/> at the end of each section!!-->                                                                                        \r\n                                                                                                                                                    \r\n\r\n        <strong>Background:<\/strong>                                                                                                    \r\n                                                                                                                                                    \r\nPulmonary hypertension (PH) secondary to congenital left-to-right shunts leads to serious consequences in sub-Saharan Africa. This study used various imaging modalities to assess right and left heart dimensions and functions in patients with secondary PH.\r\n<br \/>    \r\n\r\n        <strong>Methods:<\/strong>                                                                                                    \r\n                                                                                                                                                    \r\nPatients with a mean pulmonary artery pressure \u2265 25 mmHg during right heart catheterisation underwent transthoracic echocardiography, cardiac magnetic resonance (CMRI), and nuclear ventriculography.\r\n<br \/>\r\n                \r\n                <strong>Results:<\/strong>                                                                                                    \r\nSeventy-five patients (median age 9.98; 6.01\u201340.9 years) were included. Right-heart dilation was observed in all, with increased tricuspid valve annular diameter (median z-score 2.4) on echocardiography. Similarly, right ventricular (RV) end-diastolic indexed volumes were at least double the normal reference ranges in most patients (median 240; 165\u2013268 mL\/m\u00b2) on CMRI. The median normal RV systolic function was 49% for males (IQR 1\u2013Q3, 48.0\u201350.0%) and 49% for females (IQR1\u2013Q3, 47.3\u201349.8%). CMRI showed that 70% of males had a normal RV systolic function compared to only 45% of females (p < 0.05). Echocardiographic markers of RV function correlated poorly with CMRI RV ejection fraction, with correlation coefficients of r = \u22120.28, r = \u22120.10, and r = \u22120.04. Notably, 80% of patients demonstrated left heart dilation, and 35% had impaired left ventricular (LV) ejection fraction on echocardiography, radionuclide ventriculography, and CMRI.\r\n<br \/>\r\n                                                                                                                                                                                                                                                                        \r\n                                                                                                                                                \r\n        <strong>Conclusion:<\/strong>                                                                                                    \r\n                                                                                                                                                    \r\nEchocardiography and CMRI consistently revealed right heart dilation but correlated poorly for right heart function. The evaluation of LV function should not be neglected, as some patients exhibited decreased LV ejection fraction. A holistic approach incorporating multiple modalities and clinical assessment is recommended, as the pathophysiology of PH may differ in patients with left-to-right shunts.\r\n<br \/>    \r\n                                                                                                        \r\n\r\n                                                                                                                                                \r\n            <\/div>                                                                                                                            \r\n        <\/div>                                                                                                                                    \r\n                                                                                                                                        \r\n                                                                                                                                                \r\n        <div id=\"keywords\">                                                                                                                    \r\n                                                                                                                                            \r\n            <strong>Keywords:<\/strong>                                                                                                        \r\n                                                                                                                                            \r\n            <strong>pulmonary hypertension, congenital heart disease, echocardiography, right heart catheterisation, cardiac magnetic resonance imaging<\/strong>                                                                                                                                                                                                                    \r\n                                                                                                                                                \r\n        <\/div>                                                                                                                                    \r\n                                                                                                                                                \r\n    <div id=\"publish-info\">                                                                                                                    \r\n                                                                                                                                \r\n    <strong>Submitted:<\/strong> September 9, 2025; <!--Month day, year; -->    \r\n    <strong>Accepted:<\/strong> June 11, 2026; <!--Month day, year; -->                                                                            \r\n    <strong>Published:<\/strong> August 21, 2026<!--Month day, year; -->                                                                                                                            <br \/>                                                            \r\n        <em>Cardiovasc J Afr 2025; <b>37<\/b>: 345-353<!--pg no. till pg no. \"eg. 4-7\"--><\/em>\r\n        <br \/><strong>Volume 37, Issue 3<\/strong> <br \/>                                                                            \r\n        <\/div>                                                                                                                            \r\n                                                                                                                                        \r\n    <div id=\"DOI\">                                                                                                                    \r\n            DOI Citation Reference: dx.doi.org\/10.5830\/CVJA-2026-033<!--DOI number-->                                                                \r\n        <\/div>                                                                                                                            \r\n                \r\n                <div id=\"author-affiliation\">                                                                                                \r\n\r\n\r\n<strong>Department of Cardiology, Dr George Mukhari Academic Hospital, Pretoria, South Africa\r\n\r\n<\/strong>    <br \/>                                                                            \r\nMusawenkosi MF Henema\r\n<br \/><br \/>   \r\n\r\n<strong>Department of Health Sciences, Faculty of Health and Environmental Sciences, Central University of Technology, Bloemfontein, South Africa\r\n\r\n<\/strong>    <br \/>                                                                            \r\nMusawenkosi MF Henema<br \/>\r\nLezelle Botes\r\n<br \/><br \/>   \r\n\r\n<strong>Department of Cardiothoracic Surgery, School of Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa\r\n\r\n<\/strong>    <br \/>                                                                            \r\nFrancis E Smit\r\n<br \/><br \/>   \r\n\r\n<strong>Division Paediatric & Congenital Cardiology, School of Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa\r\n\r\n<\/strong>    <br \/>                                                                            \r\nStephen C Brown<br \/>\r\n\r\n<br \/><br \/>   \r\n  \r\n\r\n                [soshsc hide=\"logged\"]\r\n                <strong>You need to be <a style=\"color: #c80c44;\" href=\"https:\/\/cvja.co.za\/journal\/member-login\/\" target=\"_blank\" rel=\"noopener\">logged in to view and download<\/a> the full text PDF version. <a style=\"color: #c80c44;\" href=\"https:\/\/cvja.co.za\/journal\/register\/\" target=\"_blank\" rel=\"noopener\">Register for a free account?<\/a><\/strong> <br \/><br \/>[\/soshsc]\r\n                \r\n                \r\n                \r\n                <\/div>\r\n    \r\n<\/div>","protected":false},"excerpt":{"rendered":"<p>Pulmonary hypertension (PH) secondary to congenital left-to-right shunts leads to serious consequences in sub-Saharan Africa. This study used various imaging modalities to assess right and left heart dimensions and functions in patients with secondary PH.<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[44,111],"tags":[],"class_list":["post-5672","post","type-post","status-publish","format-standard","hentry","category-cardiovascular-topics","category-volume-37-issue-3"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>An analysis of imaging modalities to assess the right and left heart in pulmonary hypertension with left-to-right shunts - Cardiovascular Journal of Africa<\/title>\n<meta name=\"description\" content=\"Pulmonary hypertension (PH) secondary to congenital left-to-right shunts leads to serious consequences in sub-Saharan Africa. 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