To investigate the characteristics of pulmonary artery pressure and cardiac morphology and function in children with pneumonia and right heart failure in a high altitude area.

We reviewed the charts of 107 children diagnosed as having pneumonia with right heart failure and 107 age-, gender-, and ethnic-matched pneumonia children without right heart failure in a high altitude area. Demographic data were collected. Echocardiographic assessments included systolic pulmonary artery pressure (SPAP), cardiac morphology (including thickness of the right ventricular anterior wall and left ventricular posterior wall, and dimensions of the right atrium, left atrium, end-diastolic right ventricle and left ventricle, and end-systolic left ventricle), cardiac function (including end-systolic left ventricle and right ventricle diastolic function and left ventricle systolic and diastolic function), and the presence of congenital heart disease (CHD) or not. Serum myocardial enzymes were measured at admission.

In patients with right heart failure, SPAP increased in 30 (28.0%) children; the increase was mild in 19 patients (46±4 mmHg), moderate in 6 (70±6 mmHg), and severe in 5 (110±25 mmHg). Their overall SPAP was significantly higher (P＜0.001) with larger right cardiac morphology measures (P＜0.001~0.003) compared to those without right heart failure. Heart function was not significantly different (P＞0.05) and myocardial enzymes were within normal reference ranges. There were more patients with CHD (44.9% vs 31.8%, P=0.028). SPAP positively correlated with the right heart morphology measures, but not with the left heart morphology measures, myocardial enzymes, or troponin (P＞0.05).

Children with pneumonia and right heart failure are often associated with varied degrees of pulmonary hypertension, right heart enlargement, and hypertrophy. Despite clinical signs of right heart failure, echocardiography and myocardial enzymes show no right and left dysfunction or myocardial injury. In clinical treatment of these children, attention should be paid to the predisposition to moderate to severe pulmonary hypertension and CHD.