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

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.

Ability of the Tricuspid Annular Peak Systolic Velocity (S′) to Detect Systolic Right Ventricular Impairment After Congenital Heart Defect Surgery in Pediatric Patients

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opinion, this is an excellent manuscript describing impaired systolic and diastolic biventricular performance shortly after congenital heart defect (CHD) surgery.The authors clearly state that only tissue Doppler parameters such as the tricuspid annular peak systolic velocity (S 0 ) and the M-mode parameter tricuspid annular plane systolic excursion (TAPSE) were able to detect impairment of systolic right ventricular (RV) function [1].We completely agree with their findings and may add that in our opinion, this impairment can persist up to 1 year postoperatively. We note also that after surgery for tetralogy of Fallot, these parameters worsen continuously over time in pediatric and adolescent patients [2,3].

The authors state that a need exists for a detailed evaluation of the RV function parameters (e.g., the S 0 in this pediatric population) [1].

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“…We note also that after surgery for tetralogy of Fallot, these parameters worsen continuously over time in pediatric and adolescent patients [2,3].The authors state that a need exists for a detailed evaluation of the RV function parameters (e.g., the S 0 in this pediatric population) [1]. They found that S 0 was significantly lower in the surgically treated CHD patient group than in the control group.…”

“…We read with interest the article, Tissue Doppler Imaging Detects Impaired Biventricular Performance Shortly After Congenital Heart Defect Surgery, from Klitsie et al [1]. In our opinion, this is an excellent manuscript describing impaired systolic and diastolic biventricular performance shortly after congenital heart defect (CHD) surgery.…”

“…The authors state that a need exists for a detailed evaluation of the RV function parameters (e.g., the S 0 in this pediatric population) [1]. They found that S 0 was significantly lower in the surgically treated CHD patient group than in the control group.…”

“…The authors clearly state that only tissue Doppler parameters such as the tricuspid annular peak systolic velocity (S 0 ) and the M-mode parameter tricuspid annular plane systolic excursion (TAPSE) were able to detect impairment of systolic right ventricular (RV) function [1].…”