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Tissue Doppler Imaging Detects Impaired Biventricular Performance Shortly After Congenital Heart Defect Surgery

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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.

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Acknowledgments

The authors thank Gwen C. Bos and Eveline M. Ligthart of the pediatric echocardiography department at the Leiden University Medical Center for their efforts in performing the echocardiographic studies. Additionally, the authors thank Theo Stijnen, PhD, of the Medical Statistics and Bioinformatics Department at the Leiden University Medical Center for statistical support. Liselotte M. Klitsie is supported by a Grant of the MD/PhD project, Leiden University, Leiden, the Netherlands.

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Authors and Affiliations

  1. Department of Pediatric Cardiology, Leiden University Medical Center, P.O. Box 9600, Room J6-S, 2300 RC, Leiden, The Netherlands

    Liselotte M. Klitsie, Arno A. W. Roest, Annelies E. Van der Hulst, Nico A. Blom & Arend D. J. Ten Harkel

  2. Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands

    Mark G. Hazekamp

  3. Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands

    Birthe J. Gesink-van der Veer

  4. Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, The Netherlands

    Irene M. Kuipers

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  1. Liselotte M. Klitsie
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  2. Mark G. Hazekamp
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  4. Annelies E. Van der Hulst
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  8. Arend D. J. Ten Harkel
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Correspondence to Arend D. J. Ten Harkel.

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Klitsie, L.M., Hazekamp, M.G., Roest, A.A.W. et al. Tissue Doppler Imaging Detects Impaired Biventricular Performance Shortly After Congenital Heart Defect Surgery. Pediatr Cardiol 34, 630–638 (2013). https://doi.org/10.1007/s00246-012-0513-3

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  • DOI: https://doi.org/10.1007/s00246-012-0513-3

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