Abstract
Pulmonary hypertension (PH) is a serious complication of ventricular septal defect (VSD). Electrocardiography (ECG) effectively demonstrates right ventricular hypertrophy (RVH) in patients with PH, and this can be achieved more easily by applying right-sided chest leads in the synthesized 18-lead ECG. We examined 53 pediatric patients with VSD aged between 1 month and < 3 years who underwent the standard 12-lead ECG. Our pediatric cardiologists assessed the results of echocardiography and cardiac catheterization, and on the basis of which, classified patients as having PH (36 cases) or lacking PH (17 cases). The R and T wave amplitudes recorded via the left chest leads, V1 and V2 in the standard 12-lead ECG and syn-V3R and syn-V4R in the synthesized 18-lead ECG, were compared between the two groups. A significant intergroup difference was observed in syn-V3R and syn-V4R in the synthesized 18-lead ECG (p = 0.0001). When we determined the presence or absence of PH in the two groups using a combination of the standard 12-lead ECG on the basis of the Japanese guidelines (JCS 2009) (R and T waves of V1, and S wave of V6) and the synthesized 18-lead ECG (R of syn-V3R and syn-V4R), the sensitivity, specificity, and accuracy rate for PH were 61%, 88%, and 70% vs. 67%, 76%, and 70%, respectively. Furthermore, when the R or T wave of syn-V4R was positive, the sensitivity and specificity for the diagnosis of RVH were 89% and 82%, respectively, suggesting that PH can be easily discriminated by daily inspection.
