Abnormal left ventricular filling after neonatal repair of congenital heart disease: association with increased mortality and morbidity.
BACKGROUND
The presence of mid-diastolic flow reversal on the mitral valve Doppler inflow indicates abnormal left ventricular filling. To determine whether mid-diastolic flow reversal predicts outcome in patients undergoing repair or palliation of neonatal congenital heart disease, we reviewed the echocardiograms and medical records of 40 patients with either left ventricular outflow obstruction or transposition of the great arteries.


METHODS
All patients underwent surgical repair; transposition of the great arteries (TGA) = 17, coarctation of the aorta (CoA) = 14, interrupted aortic arch (IAA) = 8, and aortic stenosis (AS) = 1. The presence of mid-diastolic flow reversal was determined by pulsed Doppler interrogation of the mitral valve on preoperative and postoperative echocardiograms.


RESULTS
Preoperative echocardiograms showed diastolic flow reversal in only 5 patients; 1 of 1 with AS and 4 of 14 with CoA. Twenty-one of 40 patients showed postoperative diastolic flow reversal; 1 of 1 with AS, 8 of 8 with IAA, 1 of 14 with CoA, and 11 of 17 with TGA. Postoperative mid-diastolic flow reversal 1 to 3 days after surgery was associated with higher mortality rate: 7 of 21 patients with diastolic flow reversal and 0 of 19 without diastolic flow reversal died. Patients with diastolic flow reversal who survived had longer intensive care unit (26.2 +/- 13.5 days vs 7.1 +/- 4.1 days, P <.001) and hospital (57.4 +/- 38.8 days vs 14.8 +/- 5.2 days, P <.05) stays.


CONCLUSIONS
Mid-diastolic flow reversal is an indicator of prolonged hospital stay and mortality in patients with left ventricular outflow tract obstruction or TGA.
Li
J S
JS
Division of Cardiology, Department of Pediatrics, and the Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Bengur
A R
AR
Ungerleider
R M
RM
Herlong
J R
JR
Sanders
S P
SP
D003971:Diastole; D006801:Humans; D007231:Infant, Newborn; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D014188:Transposition of Great Vessels / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D018487:Ventricular Dysfunction, Left / Q000209:etiology*; D014694:Ventricular Outflow Obstruction / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*