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[Left ventricular systolic function in patients surgically treated for atrioventricular septal defect:
G Pacileo1, M G Russo, D Galzerano
1Cattedra di Cardiologia Pediatrica, Ia Facolta di Medicina e Chirurgia Ospedale v. Monaldi, Napoli.
Insights
Early surgical repair in complete atrioventricular septal defect (AVSD) improves post-operative left ventricular systolic function. This study highlights age at repair as a key factor for better outcomes in pediatric AVSD patients.
Area of Science:
- Cardiology
- Pediatric Surgery
- Echocardiography
Background:
- Complete atrioventricular septal defect (AVSD) is a congenital heart condition requiring surgical intervention.
- Assessing post-operative left ventricular systolic function is crucial for long-term outcomes in pediatric patients.
- Factors like Down syndrome, mitral regurgitation, and timing of repair may influence cardiac function after AVSD surgery.
Purpose of the Study:
- To evaluate left ventricular systolic function in pediatric patients post-AVSD surgical repair.
- To identify factors affecting post-operative systolic function, including Down syndrome, mitral regurgitation, age at repair, and follow-up duration.
Main Methods:
- Echocardiography was used to study 14 pediatric patients (mean age 20.3 months) with repaired complete AVSD.
- Load-independent indexes, including the left ventricular end systolic stress (LVESS)/circumferential fibre shortening velocity (VCFc) relationship and LVESS/end systolic volume index (ESVI) ratio, were analyzed.
- Correlation analysis was performed to assess the impact of Down syndrome, mitral regurgitation, age at repair, and follow-up duration on systolic function.
Main Results:
- Most patients exhibited normal or elevated LVESS/VCFc values; however, two patients with later surgical repair showed lower values.
- The LVESS/ESVI ratio demonstrated a significant inverse correlation between systolic function and the age of surgical correction (r = -0.75).
- Down syndrome, residual mitral regurgitation, and follow-up length did not show a significant correlation with post-operative systolic function.
Conclusions:
- In this cohort, the age at which surgical repair for complete AVSD is performed is the primary determinant of post-operative left ventricular systolic function.
- Earlier surgical intervention appears to be associated with better systolic function in pediatric patients with complete AVSD.
Abstract:
In order to assess the left ventricular systolic function we studied by echo 14 pts (8M, 6F) with complete atrioventricular septal defect (AVSD) who had undergone surgical repair. Mean age was 20.30 +/- 24.63 months, with a follow-up of 52.85 +/- 19.11%; in 6 pts Down syndrome was associated. Particularly, we tried to determine whether the following factors might affect the post-operative left ventricular systolic function: a) Down syndrome; b) residual mild mitral regurgitation; c) age of the surgical repair; d) length of the follow-up. As load-independent indexes of contractility, the left ventricular end systolic stress (LVESS)-circumferential fibre shortening velocity normalized for heart rate (VCFc) relationship and the LVESS/end systolic volume index (ESVI) ratio were chosen. All pts showed normal (mean +/- 2 standard deviations) or slightly higher values of LVESS/VCFc relationship; significantly, the only two pts with lower values had later undergone surgical repair. LVESS/ESVI ratio confirmed an inverse relationship between systolic function and age of the surgical correction (r = -0.75); no other factors (Down syndrome, residual mild mitral regurgitation, length of the follow-up) showed a significant correlation with the post-operative left ventricular systolic function. In conclusion, in our limited population, the age of the surgical repair appears to be the main factor affecting the post surgical left ventricular systolic function in pts with complete AVSD.