title: Tissue Doppler imaging detects impaired biventricular performance shortly after congenital heart defect surgery.
abstract: Cardiac surgery with cardiopulmonary bypass is associated with the development of a systemic inflammatory response, which can lead to myocardial damage. However, knowledge concerning the time course of ventricular performance deterioration and restoration after correction of a congenital heart defect (CHD) in pediatric patients is sparse. Therefore, the authors perioperatively quantified left ventricular (LV) and right ventricular (RV) performance using echocardiography. Their study included 141 patients (ages 0-18 years) undergoing CHD correction and 40 control subjects. The study assessed LV systolic performance (fractional shortening) and diastolic performance (mitral Doppler flow) in combination with RV systolic performance [tricuspid annular plane systolic excursion (TAPSE)] and diastolic performance (tricuspid Doppler flow). Additionally, systolic (S') and diastolic (E', A', E/E') tissue Doppler imaging (TDI) measurements were obtained at the LV lateral wall, the interventricular septum, and the RV free wall. Echocardiographic studies were performed preoperatively, 1 day postoperatively, and at hospital discharge after 9 ± 5 days. Although all LV echocardiographic measurements showed a deterioration 1 day after surgery, only LV TDI measurements were impaired in patients at discharge versus control subjects (S': 5.7 ± 2.0 vs 7.1 ± 2.7 cm/s; E': 9.8 ± 3.9 vs 13.7 ± 5.1 cm/s; E/E': 12.2 ± 6.4 vs 8.8 ± 4.3; p < 0.05). In the RV, TAPSE and RV TDI velocities also were impaired in patients at discharge versus control subjects (TAPSE: 9 ± 3 vs 17 ± 5 mm; S': 5.2 ± 1.7 vs 11.4 ± 3.4 cm/s; E': 7.3 ± 2.5 vs 16.3 ± 5.2 cm/s; E/E': 12.5 ± 6.8 vs 4.8 ± 1.9; p < 0.05). Furthermore, longer aortic cross-clamp times were associated with more impaired postoperative LV and RV performance (p < 0.05). In conclusion, both systolic and diastolic biventricular performances were impaired shortly after CHD correction. This impairment was detected only by TDI parameters and TAPSE. Furthermore, a longer-lasting negative influence of cardiopulmonary bypass on myocardial performance was suggested.
authors.affiliation: Department of Pediatric Cardiology, Leiden University Medical Center, P.O. Box 9600, Room J6-S, 2300 RC, Leiden, The Netherlands.
authors.forename: Liselotte M
authors.initials: LM
authors.lastname: Klitsie
authors.forename: Mark G
authors.initials: MG
authors.lastname: Hazekamp
authors.forename: Arno A W
authors.initials: AA
authors.lastname: Roest
authors.forename: Annelies E
authors.initials: AE
authors.lastname: Van der Hulst
authors.forename: Birthe J
authors.initials: BJ
authors.lastname: Gesink-van der Veer
authors.forename: Irene M
authors.initials: IM
authors.lastname: Kuipers
authors.forename: Nico A
authors.initials: NA
authors.lastname: Blom
authors.forename: Arend D J
authors.initials: AD
authors.lastname: Ten Harkel
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D016022:Case-Control Studies; D015984:Causality; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D018619:Echocardiography, Doppler, Pulsed / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology