Clinical Utility and Limitations of TAPSE in Pediatric Echocardiography: A Narrative Review

BACKGROUND: Tricuspid annular plane systolic excursion (TAPSE) is widely used to assess right ventricular (RV) longitudinal systolic function in pediatric echocardiography; however, its reliability is influenced by developmental physiology. OBJECTIVE: To evaluate the clinical utility, age-dependent variability, and limitations of TAPSE in pediatric populations. METHODS: A narrative review of literature published between 1990 and 2025 was conducted using PubMed, Scopus, and Google Scholar. Studies evaluating TAPSE in pediatric populations (0-18 years) were included. RESULTS: Thirty-two studies were included. TAPSE correlates well with RV systolic function in older children and adolescents, supported by age- and body surface area-adjusted reference values. In neonates and infants, TAPSE is lower and more variable due to transitional physiology and altered loading conditions. TAPSE is clinically useful in pulmonary hypertension, congenital heart disease, cardiomyopathy, and posttransplant monitoring. CONCLUSION: TAPSE is a practical and reproducible marker of RV systolic function in children, particularly beyond infancy. In infants, interpretation should be cautious and integrated with complementary echocardiographic indices. Composite measures such as TAPSE/PASP may improve prognostic assessment.