Postoperative assessment of left ventricular function by two-dimensional strain (speckle tracking) after paediatric cardiac surgery.
BACKGROUND
Left ventricular (LV) dysfunction may complicate paediatric cardiac surgery with cardiopulmonary bypass, notably after long aortic cross-clamping (ACC). Assessment of occult myocardial injury by conventional echocardiographic variables may be difficult in the postoperative period.


OBJECTIVE
To evaluate the feasibility of two-dimensional (2D) strain in the postoperative period, and to assess the effect of ACC duration on this variable.


METHODS
Thirty-three paediatric patients (age<18years) with congenital heart disease undergoing cardiac surgery with cardiopulmonary bypass were included in this prospective single-centre study. Daily echocardiography was performed from the day before surgery to the fifth postoperative day. LV ejection fraction and LV 2D strain were measured. The cohort was divided into three groups according to ACC duration (group 1:<30minutes; group 2: 30-80minutes; group 3:>80minutes).


RESULTS
Mean age and weight were 4.2±2.5years and 15.1±5.2kg, respectively. Feasibilities of longitudinal, circumferential and radial strains were good, and quite similar to conventional variables. Compared with conventional variables, intra- and interobserver agreements regarding 2D strain were better (r=0.916, P<0.001 and r=0.855, P<0.001 for longitudinal strain versus r=0.156, P=0.54 and r=0.064, P=0.80 for LV ejection fraction by Simpson's method). Postoperative evolution of longitudinal and circumferential strains was significantly different between the three groups (P<0.001), whereas there was no difference using conventional variables.


CONCLUSIONS
Postoperative LV 2D strain is a feasible and reproducible method. Strain measurements seem to indicate correlation with ACC duration.
Paediatric Cardiology Unit, hôpital Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France. Electronic address: elop85@yahoo.fr.
Elodie
E
Perdreau
Paediatric Cardiology Unit, hôpital Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France.
Pierre-Emmanuel
PE
Séguéla
Paediatric Cardiology Unit, hôpital Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France.
Zakaria
Z
Jalal
Paediatric Cardiology Unit, hôpital Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France.
Adrien
A
Perdreau
Paediatric Cardiology Unit, hôpital Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France.
Jean-Baptiste
JB
Mouton
Paediatric Cardiology Unit, hôpital Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France.
Marie
M
Nelson-Veniard
Paediatric Cardiology Unit, hôpital Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France.
Elodie
E
Guillet
Paediatric Cardiology Unit, hôpital Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France.
Xavier
X
Iriart
Paediatric Cardiology Unit, hôpital Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France.
Alexandre
A
Ouattara
Paediatric Cardiology Unit, hôpital Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France.
François
F
Roubertie
Paediatric Cardiology Unit, hôpital Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France.
Philippe
P
Mauriat
Paediatric Cardiology Unit, hôpital Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France.
Jean-Benoit
JB
Thambo
D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D016277:Ventricular Function, Left / Q000502:physiology*
Cardiopathie congenitale; Cardiopulmonary bypass; Circulation extracorporelle; Congenital heart disease; Echocardiography; Function ventriculaire gauche; Left ventricular function; Échocardiographie