Ventricular Performance After Surgery for a Congenital Heart Defect as Assessed Using Advanced Echocardiography: From Doppler Flow to 3D Echocardiography and Speckle-Tracking Strain Imaging

Abstract

A varying degree of impairment of ventricular performance is observed over the long-term after surgery for a congenital heart defect (CHD). Impaired ventricular performance has been shown to be of prognostic value for increased risk of cardiovascular events in adult CHD patients. This emphasizes the importance of delineating the timing and cause of this postoperative impairment. Impairment of ventricular performance could develop over time as a consequence of residua, sequelae and complications of the CHD or surgical procedure. Yet, impaired ventricular performance has also been observed immediately after surgery and can persist and/or worsen over time. This postoperative impairment of ventricular performance is the focus of this review. This article provides an overview of echocardiographic techniques currently used to assess ventricular performance. Furthermore, we review current literature describing ventricular performance, as assessed using echocardiography, after correction of a CHD. In general, a decrease in ventricular performance is observed directly after surgery for CHD’s. Subsequent follow-up of ventricular performance is characterized by a varying degree of postoperative recovery. A consistent observation is the persistent impairment of right-ventricular performance after repair in several different subgroups of CHD patients ranging from ventricular septal defect repair to surgery for Tetralogy of Fallot.

Decreased biventricular longitudinal strain shortly after congenital heart defect surgery

“…In patients with a corrected CHD, postoperative impaired ventricular performance can lead to heart failure and has a prognostic value for increased risk of cardiovascular events in adulthood . Residual defects, surgical scars as well as the use of cardiopulmonary bypass (CPB) may contribute to the impaired ventricular performance . Yet, much is still unclear regarding the timing of decrease in ventricular performance postoperatively and the best way to quantify this.…”

Regional Ventricular Performance and Exercise Training in Children and Young Adults After Repair of Tetralogy of Fallot

“…These assumptions do not necessarily hold in patients with ConHD. 17 TDI is less dependent of chamber geometry and enables assessment of global and regional ventricular performance. 17 Changes in regional systolic and diastolic ventricular performance have been recognized as more sensitive markers of deterioration of function than conventional markers in patients with acquired heart disease as well as ConHD.…”

“…17 TDI is less dependent of chamber geometry and enables assessment of global and regional ventricular performance. 17 Changes in regional systolic and diastolic ventricular performance have been recognized as more sensitive markers of deterioration of function than conventional markers in patients with acquired heart disease as well as ConHD. 13 Changes related to acute bouts of exercise in normal but untrained hearts may include enhanced diastolic filling velocities, as has been shown by an increase of peak diastolic velocities measured with TDI during exercise.…”

Multimodality Imaging for Left Ventricular Hypertrophy Severity Grading: A Methodological Review

“…This currently widespread technique is based on ultrasound waves directed to the heart, which are reflected and translated into several modalities that can be used to assess LVH, namely: M-mode echocardiography; two-dimensional echocardiography (2DE), and three-dimensional echocardiography (3DE) images 19)20). The most important advantages of echocardiography are its wide accessibility, lack of radiation exposure, and excellent temporal resolution, which is superior to all other imaging techniques.…”

“…M-mode echocardiography, often used for LVH assessment, has a temporal resolution up to 1 ms. However, echocardiography is operator and patient dependent, which could result in a relatively high inter-observer variability 20)21)22). Furthermore, geometric assumptions represent an important limitation in LVM estimation in M-mode and 2DE, but this can be overcome by the use of 3DE: when 3DE measurements of LVM are compared to CMR measurements as gold standard, they correlate better, and have smaller limits of agreements, than LVM measurements with 2DE 23)24).…”