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Regional right and left ventricular function after the Senning operation: an ultrasonic study of strain rate and strain

Published online by Cambridge University Press:  21 January 2005

Benedicte Eyskens ,
Frank Weidemann ,
Miroslaw Kowalski ,
Jan Bogaert ,
Steven Dymarkowski ,
Bart Bijnens ,
Marc Gewillig ,
George Sutherland  and
Luc Mertens
Benedicte Eyskens
Affiliation:
Department of Pediatric Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
Frank Weidemann
Affiliation:
Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
Miroslaw Kowalski
Affiliation:
Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
Jan Bogaert
Affiliation:
Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium
Steven Dymarkowski
Affiliation:
Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium
Bart Bijnens
Affiliation:
Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
Marc Gewillig
Affiliation:
Department of Pediatric Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
George Sutherland
Affiliation:
Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
Luc Mertens
Affiliation:
Department of Pediatric Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
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Abstract

Background: Systemic right ventricular dysfunction is a major concern in the follow-up of patients who underwent an atrial redirection procedure for transposition (concordant atrio-ventricular and discordant ventriculo-arterial connections). No good non-invasive method is currently available for quantifying right ventricular function. Aims: We have used ultrasonically based imaging of strain rate and strain to quantify regional deformation in the right ventricle after the Senning operation, comparing properties of regional deformation of the right ventricle with right ventricular ejection fraction as measured using magnetic resonance imaging. Methods: In 20 asymptomatic patients who had undergone the Senning procedure, we measured peak systolic strain rate and systolic strain values in the right ventricular free wall, the septum and the left ventricular lateral wall using colour Doppler myocardial imaging, comparing the data with findings obtained in 30 healthy subjects. Global right ventricular ejection fraction was assessed using magnetic resonance imaging. Results: Properties of deformation of the right ventricular free wall were reduced and homogeneous after the Senning procedure compared to normals, with significantly lower values for peak systolic strain rate and systolic strain (−1.1 ± 0.4 vs. −2.5 ± 0.9 s−1; p < 0.05 and −16 ± 7% vs. −38 ± 13%; p < 0.05, respectively). There was a significant correlation between regional longitudinal right ventricular systolic strain values and right ventricular ejection fraction (r = −0.87, p < 0.001). In the septum, peak systolic strain rate was again reduced and homogeneous (−1.2 ± 0.4 vs. −1.8 ± 0.5 s−1; p < 0.05 vs. normals). Also in the left ventricle, the lateral wall peak systolic strain rate and systolic strain values were reduced (−1.5 ± 0.5 vs. −2.1 ± 0.9 s−1; p < 0.05 and −20 ± 6% vs.−25 ± 9%; p < 0.05, vs. normals, respectively). Conclusions: Properties of regional longitudinal deformation of the systemic right ventricle are reduced after the Senning procedure compared to normal controls, and correlate well with global right ventricular performance. These findings suggest that ultrasonic strain rate and strain imaging could be used in the non-invasive follow-up of ventricular function in these patients.

Keywords

Echocardiographydiscordant ventriculo-arterial connectionstranspositionregional myocardial function
Type
Original Article
Information
Cardiology in the Young , Volume 14 , Issue 3 , June 2004 , pp. 255 - 264
Copyright
© 2004 Cambridge University Press

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References

Birnie D, Tometzki A, Curzio J, et al. Outcomes of transposition of the great arteries in the era of atrial inflow correction. Heart 1998; 80: 170–173.Google Scholar
Oechslin E, Jenni R. 40 Years after the first atrial switch procedure in patients with transposition of the great arteries: long-term results in Toronto and Zurich. Thorac Cardiovasc Surg 2000; 48: 233–237.Google Scholar
Sarkar D, Bull C, Yates R, et al. Comparison of long-term outcomes of atrial repair of simple transposition with implications for late arterial switch strategy. Circulation 1999; 100 (Suppl 19): I76–I81.Google Scholar
Turina MI, Siebenmann R, von Segesser L, Schonbeck M, Senning A. Late functional deterioration after atrial correction for transposition of the great arteries. Circulation 1989; 80: I162–I167.Google Scholar
Von Segesser L, Fry M, Senning A, Turina MI. Atrial repair for transposition of the great arteries: current approach in Zurich based on 24 years of follow-up. Thorac Cardiovasc Surg 1991; 39 (Suppl 2): 185–189.Google Scholar
Kirjavainen M, Happonen JM, Louhimo I. Late results of Senning operation. Thorac Cardiovasc Surg 1999; 117: 488–495.Google Scholar
Labbe L, Douard H, Barat JL, et al. Alteration of myocardial viability and systemic ventricular dysfunction after Senning procedure. Arch Mal Coeur Vaiss 1997; 90: 631–637.Google Scholar
Martin RP, Qureshi SA, Ettedgui JA, et al. An evaluation of right and left ventricular function after anatomical correction and intra-atrial repair operations for complete transposition of the great arteries. Circulation 1990; 82: 808–816.Google Scholar
Reich O, Voriskova M, Ruth C, et al. Long-term ventricular performance after intra-atrial correction of transposition: left ventricular filling is the major limitation. Heart 1997; 78: 376–381.Google Scholar
Helbing WA, Hansen B, Ottenkamp J, et al. Long-term results of atrial correction for transposition of the great arteries. Comparison of Mustard and Senning operations. J Thorac Cardiovasc Surg 1994; 108: 363–372.Google Scholar
Lidegran M, Odhner L, Jacobsson LA, Geitz D, Lundell B. Magnetic resonance imaging and echocardiography in assessment of ventricular function in atrially corrected transposition of the great arteries. Scand Cardiovasc J 2000; 34: 384–389.Google Scholar
Helbing WA, Rebergen SA, Maliepaard C, et al. Quantification of right ventricular function with magnetic resonance imaging in children with normal hearts and with congenital heart disease. Am Heart J 1995; 130: 828–837.Google Scholar
Heimdal A, D'hooge J, Bijnens B, Sutherland GR, Torp H. In vitro validation of in-plane strain rate imaging. A new ultrasound technique for evaluating regional myocardial deformation based on tissue-Doppler imaging. Echocardiography 1998; 15: s40 (Abstr).Google Scholar
Miyatake K, Yamagishi M, Tanaka N, et al. New method for evaluating left ventricular wall motion by colour-coded tissue-Doppler imaging: in vitro and in vivo studies. J Am Coll Cardiol 1995; 25: 717–724.Google Scholar
Urheim S, Edvardsen T, Torp T, Angelsen B, Smiseth O. Myocardial strain by Doppler echocardiography. Validation of a new method to quantify regional myocardial function. Circulation 2000; 102: 1158–1164.Google Scholar
Gorcsan J III, Strum DP, Mandarino WA, Gulati UK, Pinsky MR. Quantitative assessment of alterations in regional left ventricular contractility with colour-coded tissue-Doppler echocardiography. Comparison with sonomicrometry and pressure–volume relations. Circulation 1997; 95: 2423–2433.Google Scholar
D'hooge J, Heimdal A, Jamal F, et al. Regional strain and strain rate measurements by cardiac ultrasound: principles, implementation and limitations. Eur J Echocardiogr 2000; 1: 154–170.Google Scholar
Heimdal A, Stoylen A, Torp H, Skjaerpe T. Real-time strain rate imaging of the left ventricle by ultrasound. J Am Soc Echocardiogr 1998; 11: 1013–1019.Google Scholar
Isaaz K. What are we actually measuring by Doppler tissue imaging? J Am Coll Cardiol 2000; 36: 897–899.Google Scholar
Abraham TP, Nishimura RA. Myocardial strain: can we finally measure contractility? J Am Coll Cardiol 2001; 37: 731–734.Google Scholar
Weidemann F, Eyskens B, Jamal F, et al. Quantification of regional left and right ventricular radial and longitudinal function in healthy children using ultrasound-based strain rate and strain imaging. J Am Soc Echocardiogr 2002; 15: 20–28.Google Scholar
Kapusta L, Thijssen JM, Cuypers MHM, Peer PGM, Daniels O. Assessment of myocardial velocities in healthy children using tissue Doppler imaging. Ultrasound Med Biol 1999; 26: 229–237.Google Scholar
Weidemann F, Eyskens B, Mertens L, et al. Quantification of regional right and left ventricular function by ultrasonic strain rate and strain indices in Friedreich's ataxia. Am J Cardiol 2003; 91: 622–626.Google Scholar
Weidemann F, Eyskens B, Mertens L, et al. Quantification of regional right and left ventricular function by ultrasonic strain rate and strain indexes after surgical repair of tetralogy of Fallot. Am J Cardiol 2002; 90: 133–138.Google Scholar
Weidemann F, Jamal F, Sutherland GR, et al. Myocardial function defined by strain rate and strain during alterations in inotropic states and heart rate. Am J Physiol Heart Circ Physiol 2002; 283: 792–799.Google Scholar
Snider AR, Serwer GA, Ritter SB. Methods for obtaining quantitative information from the echocardiographic examination. In: Echocardiography in Pediatric Heart Disease, 2nd edn. Mosby-Year Book, London, 1997, pp 187–190.
Skulstad H, Edvardsen T, Urheim S, et al. Postsystolic shortening in ischemic myocardium: active contraction or passive recoil? Circulation 2002; 106: 718–724.Google Scholar
Greenberg NL, Firstenberg MS, Castro PL, et al. Doppler-derived myocardial systolic strain rate is a strong index of left ventricular contractility. Circulation 2002; 105: 99–105.Google Scholar
Penkoske PA, Westerman GR, Marx GR, et al. Transposition of the great arteries and ventricular septal defect: results with the Senning operation and closure of the ventricular septal defects in infants. Ann Thorac Surg 1983; 36: 281–288.Google Scholar
Lubiszewska B, Gosiewska E, Hoffman P, et al. Myocardial perfusion and function of the systemic right ventricle in patients after atrial switch procedure for complete transposition: long-term follow-up. J Am Coll Cardiol 2000; 36: 1365–1370.Google Scholar
Geva T, Powell AJ, Crawford EC, Chung T, Colan SD. Evaluation of regional differences in right ventricular systolic function by acoustic quantification echocardiography and cine magnetic resonance imaging. Circulation 1998; 98: 339–345.Google Scholar
Naito H, Arisawa J, Harada K, Yamagami H, Kozuka T, Tamura S. Assessment of right ventricular regional contraction and comparison with the left ventricle in normal humans: a cine magnetic resonance study with presaturation myocardial tagging. Br Heart J 1995; 74: 186–191.Google Scholar
Redington AN. The Mustard and Senning procedures: assessment of right ventricular performance. In: The Right Heart in Congenital Heart Disease. Greenwich Medical Media Ltd, London, 1998, pp 203–208.
Fogel MA, Weinberg PM, Fellows KE, Hoffman EA. A study in ventricular–ventricular interaction. Single right ventricles compared with systemic right ventricles in a dual-chamber circulation. Circulation 1995; 92: 219–230.Google Scholar
Wyse RK, Macartney FJ, Rohmer J, Ottenkamp J, Brom AG. Differential atrial filling after Mustard and Senning repairs. Detection by transcutaneous Doppler ultrasound. Br Heart J 1980; 44: 692–698.Google Scholar
Nascimento R, Cunha DL, Bastos P, Vanzeller P, Rodrigues-Gomes M. Echo-study of right ventricular filling in asymptomatic patients with Senning operation for transposition of the great arteries. Am J Cardiol 1991; 68: 693–695.Google Scholar
Götte MJW, van Rossum AC, Twisk JWR, Kuijer JPA, Marcus JT, Visser CA. Quantification of regional contractile function after infarction: strain analysis superior to wall thickening analysis in discriminating infarct from remote myocardium. J Am Coll Cardiol 2001; 37: 808–817.Google Scholar