title: Disparity in right vs left ventricular recovery during follow-up after ventricular septal defect correction in children.
abstract: OBJECTIVE
  Long-term prognosis after ventricular septal defect (VSD) correction in childhood is excellent. Nevertheless, decreased biventricular systolic performance has been described immediately following VSD surgery in children. In an effort to better understand this decrease and its time-course, we characterized biventricular systolic performance following VSD closure in paediatric patients up to 20 months postoperatively.
  
  
  METHODS
  Thirty-nine children undergoing VSD surgery and 22 age-matched controls were included for echocardiographic follow-up of left (LV) and right ventricular (RV) systolic performance. LV fractional shortening and tricuspid annular plane systolic excursion (TAPSE) were assessed. Additionally, tissue Doppler imaging measurements were obtained at the basal LV lateral wall and RV free wall to assess both LV and RV systolic (S(')) performance. Studies were performed preoperatively, 1 day postoperatively, at discharge and 3-20 months postoperatively at medium-term follow-up.
  
  
  RESULTS
  After an initial decrease in biventricular systolic performance, a significant recovery was observed within the first year after VSD surgery. After a medium-term follow-up of 8.4 ± 5.3 months, LV systolic performance parameters were normalized, while RV systolic performance parameters remained impaired in patients vs controls (TAPSE: 12.5 ± 1.2 vs 18.5 ± 3.2 mm, RV S('):8.9 ± 1.3 vs 12.5 ± 2.2 cm/s).
  
  
  CONCLUSIONS
  Within the first year after VSD correction, LV systolic performance had normalized, while RV systolic performance remained significantly impaired up to 20 months after VSD closure. Both detrimental effects of open heart surgery with cardiopulmonary bypass and preoperative alterations may add to the observed postoperative impairment of specifically RV performance.
authors: Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, Netherlands.
authors: Liselotte M
authors: LM
authors: Klitsie
authors: Irene M
authors: IM
authors: Kuipers
authors: Arno A W
authors: AA
authors: Roest
authors: Annelies E
authors: AE
authors: Van der Hulst
authors: Theo
authors: T
authors: Stijnen
authors: Mark G
authors: MG
authors: Hazekamp
authors: Nico A
authors: NA
authors: Blom
authors: Arend D J
authors: AD
authors: Ten Harkel
mesh_terms: D002315:Cardiopulmonary Bypass; D016022:Case-Control Studies; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000502:physiology*; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011184:Postoperative Period; D011379:Prognosis; D013599:Systole / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology; D016278:Ventricular Function, Right / Q000502:physiology
keywords: Cardiopulmonary bypass; Child; Echocardiography; Heart septal defects; Tissue Doppler imaging; Ventricular