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Prediction of postoperative left ventricular pump function in congenital mitral regurgitation
T Murakami1, M Nakazawa, T Nakanishi
1Department of Pediatric Cardiology, The Heart Institute of Japan, Tokyo Women's Medical College, Tokyo, Japan.
Insights
Predicting postoperative heart function in children with congenital mitral regurgitation is challenging. Preoperative predictive wall stress effectively estimates future left ventricular fractional shortening after surgery.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Echocardiography
Background:
- Estimating postoperative left ventricular systolic function in children with severe chronic mitral regurgitation lacks defined predictors.
- Previous studies focused on adult patients, leaving a gap in pediatric understanding.
Purpose of the Study:
- To identify reliable predictors of postoperative left ventricular fractional shortening in pediatric patients with isolated congenital mitral regurgitation.
- To evaluate the correlation between preoperative echocardiographic parameters and postoperative cardiac function.
Main Methods:
- Retrospective analysis of eight pediatric patients with isolated congenital mitral regurgitation undergoing surgical correction.
- Preoperative and postoperative echocardiographic assessments including fractional shortening, ventricular dimensions, and wall stress.
- Statistical correlation analysis between preoperative predictors and postoperative left ventricular fractional shortening.
Main Results:
- Preoperative fractional shortening, ventricular dimension indices, and end-systolic wall stress/dimension index showed poor correlation with postoperative outcomes.
- Predictive wall stress, derived from preoperative end-diastolic dimension, end-diastolic wall thickness, and diastolic blood pressure, demonstrated a strong inverse correlation with postoperative left ventricular fractional shortening (r = -0.90, p = 0.0024).
Conclusions:
- Predictive wall stress is a valuable tool for estimating postoperative left ventricular performance in children with congenital mitral regurgitation.
- Postoperative afterload, in addition to myocardial contractility, must be considered for accurate assessment of ventricular function in these patients.
Abstract:
In adult patients with severe chronic mitral regurgitation, many predictors for estimating postoperative left ventricular systolic function have been proposed. However, none has been defined in children. We analyzed the relationship between such predictors and postoperative left ventricular fractional shortening in children with isolated congenital mitral regurgitation. Eight patients with isolated congenital mitral regurgitation were examined before and after surgery with echocardiography. Fractional shortening, left ventricular end-diastolic and end-systolic dimension indices, and left ventricular end-systolic wall stress/left ventricular end-systolic dimension index in the preoperative status were poorly correlated with postoperative left ventricular fractional shortening. Predictive wall stress, which was calculated from preoperative data of end-diastolic dimension, end-diastolic wall thickness, and diastolic blood pressure, correlated well with postoperative left ventricular fractional shortening (r = -0.90, p = 0.0024). It is important to consider not only myocardial contractility but also postoperative afterload for estimating postoperative left ventricular performance in chronic severe mitral regurgitation.