Decreased biventricular longitudinal strain shortly after congenital heart defect surgery.
OBJECTIVE
Impaired ventricular performance in patients who underwent surgery for congenital heart defect (CHD) may ultimately result in clinical heart failure. It is therefore important to regularly evaluate the left ventricular (LV) and right ventricular (RV) performance. We evaluated tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) before and after surgical correction of a CHD.


METHODS
Patients with CHD undergoing biventricular corrective surgery were included in this retrospective study. In addition, a group of healthy controls was included. The performance of LV, RV and interventricular septum (IVS) was assessed using mitral inflow velocities, TDI peak systolic (S'), peak early (E') and peak late (A') diastolic velocity. LV and RV global longitudinal strain (GLS) were assessed using STE. Measurements were performed preoperatively and at discharge.


RESULTS
A total of 204 patients and 78 controls were included. All TDI measurements were significantly decreased after surgery. Nonetheless, LV S' and A' were still within normal limits. LV and RV GLS were significantly reduced after surgery and significantly lower compared to controls. A longer aortic cross-clamp time and cardiopulmonary bypass (CPB) time were associated with significantly lower TDI and strain parameters in the RV and IVS, but not in the LV.


CONCLUSIONS
TDI and STE results generally imply a significantly lower ventricular performance in patients with CHD postoperatively. Furthermore, a negative correlation was observed between aortic cross-clamping and CPB time and several RV performance parameters. As this association was not observed in the LV, this could implicate less vulnerability of the LV to cardiopulmonary bypass.
Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
Jonne M
http://orcid.org/0000-0003-1178-8457
JM
de Boer
Division of Pediatric Cardiology, Department of Pediatrics, Academic Medical Center, Amsterdam, The Netherlands.
Irene M
IM
Kuipers
Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
Liselotte M
LM
Klitsie
Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.|Division of Pediatric Cardiology, Department of Pediatrics, Academic Medical Center, Amsterdam, The Netherlands.
Nico A
NA
Blom
Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
Arend D J
AD
Ten Harkel
D002675:Child, Preschool; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D018754:Ventricular Dysfunction / Q000000981:diagnostic imaging*; D016276:Ventricular Function / Q000502:physiology*
congenital heart disease; echocardiography; tissue Doppler imaging; ventricular function