Longitudinal mechanics as predictors of left ventricular systolic function in the early postoperative period after surgical perimembranous ventricular septal defect closure in children aged <1 year
<p><strong>Aim.</strong> To evaluate left ventricular systolic function in the early postoperative period after surgical perimembranous ventricular septal defect (VSD) closure in children aged <1 year using longitudinal mechanics.</p><p><strong>Methods.<...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Meshalkin National Medical Research Center
2019-07-01
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| Series: | Патология кровообращения и кардиохирургия |
| Subjects: | |
| Online Access: | https://journalmeshalkin.ru/index.php/heartjournal/article/view/668 |
| Summary: | <p><strong>Aim.</strong> To evaluate left ventricular systolic function in the early postoperative period after surgical perimembranous ventricular septal defect (VSD) closure in children aged <1 year using longitudinal mechanics.</p><p><strong>Methods.</strong> Between 2014 and 2017, we examined 65 children aged 2–11 months with perimembranous VSD (mean diameter = 8.6 ± 1.7 mm) and a pulmonary-to-systemic blood flow ratio of >1.5/1. The longitudinal mechanics of the left ventricle (LV) were assessed using vector velocity imaging. All the children underwent surgical perimembranous VSD closure. Echocardiographic studies were performed preoperatively, immediately postoperatively, and 1 and 20 days postoperatively.</p><p><strong>Results.</strong> In all the children, significant decreases in the LV end-systolic volume index, end-diastolic volume index, stroke volume index (SVI), and ejection fraction (EF) were identified immediately postoperatively when compared with the preoperative findings. One day postoperatively, the LV volume data normalized; however, in 10.8% of the children, the SVI and EF remained impaired. The percentage EF reduction showed weak correlations with the childrens’ weights (Rs = 0.3; p = 0.039), aortic cross-clamping durations (Rs = 0.36; p = 0.03), and VSD sizes (Rs = 0.33; p = 0.006). Twenty days postoperatively, the LV volumetric parameters normalized; however, the EF did not reach the initial value. The longitudinal strain and strain rate were reduced preoperatively when compared with normal values. For the prediction of a postoperatively significant EF reduction (≤35%), the preoperative LV strain had a sensitivity of 88%, specificity of 98.2%, and cutoff value of –9.2%; the LV strain rate had a sensitivity of 87.8%, specificity of 94.7%, and cutoff value of –0.47 s<sup>−</sup><sup>1</sup>.</p><p><strong>Conclusion.</strong> Children aged <1 year with perimembranous VSD showed reductions in the longitudinal mechanics of the LV, reflecting subclinical systolic dysfunction. One day after surgical correction, a transient decrease in LV systolic function was noted in all the children; however, a significantly impaired LV systolic function was noted in 10.8% of the children. Our findings indicate that the longitudinal mechanics of the LV can predict LV systolic dysfunction in the early postoperative period with high sensitivity and specificity.</p><p>Received 17 January 2019. Revised 18 April 2019. Accepted 25 April 2019.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p> |
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| ISSN: | 1681-3472 2500-3119 |