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Published on: November 28, 2018
Segmental differences of impaired diastolic relaxation following cardiopulmonary bypass surgery in children: a tissue
Linda B Pauliks1, Akif Undar, J Brian Clark
1Department of Pediatrics, Penn State College of Medicine, Penn State Children's Hospital, Hershey, PA 17033, USA. lpauliks@hmc.psu.edu
Insights
Cardiopulmonary bypass (CPB) impairs myocardial relaxation in children. Tissue Doppler imaging revealed significant diastolic dysfunction post-surgery, with right ventricle mechanics most affected, highlighting a sensitive tool for assessing recovery.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Echocardiography
Background:
- Impaired myocardial relaxation is a known complication of cardiopulmonary bypass (CPB).
- Pediatric patients, particularly infants, are vulnerable due to immature calcium metabolism.
- Quantifying diastolic dysfunction clinically has been challenging.
Purpose of the Study:
- To assess regional diastolic myocardial velocities using tissue Doppler in pediatric patients after open heart surgery.
- To evaluate the recovery of myocardial function following CPB.
- To investigate potential differences in recovery between left and right ventricles and between longitudinal and radial myocardial motion.
Main Methods:
- Tissue Doppler imaging was used to measure early (E) and atrial (A) diastolic velocities.
- Regional diastolic myocardial velocities were assessed in 31 pediatric patients before and 8, 24 hours after CPB surgery.
- Long axis and radial wall motion were analyzed from specific echocardiographic views.
Main Results:
- Abnormal left ventricle (LV) and right ventricle (RV) diastolic relaxation was observed in the early postoperative phase after CPB.
- Initially, all myocardial segments showed significant alterations.
- By 24 hours post-CPB, LV radial wall motion recovered, but longitudinal fibers in both LV and RV showed less resilience, with RV myocardial mechanics being most abnormal.
Conclusions:
- Tissue Doppler analysis provides a sensitive method for evaluating regional myocardial function and recovery after CPB in pediatric patients.
- The findings suggest differential recovery patterns of myocardial fibers, with longitudinal function being less resilient.
- This technique may aid in comparing the efficacy of different cardioprotective strategies in pediatric cardiac surgery.
Abstract:
Impaired myocardial relaxation is an important aftereffect of cardiopulmonary bypass (CPB). Infants with their immature calcium metabolism may be particularly vulnerable. However, it has been difficult to quantitate diastolic dysfunction clinically. This study used tissue Doppler to measure regional diastolic myocardial velocities in 31 pediatric patients undergoing open heart surgery. Color tissue Doppler images were acquired in the operating room before and 8 and 24 h post CPB surgery. Early (E) and atrial (A) diastolic velocities were determined. Long axis motion was assessed from apical views near the mitral and tricuspid rings and radial wall motion from the parasternal view. The study included 31 children aged 3.6 +/- 4.4 years (6 days to 16 years), with a mean weight of 14.7 +/- 13.7 kg and body surface area of 0.59 +/- 0.35 m(2). Tissue Doppler analysis of regional wall motion revealed abnormal left ventricle (LV) and right ventricle (RV) diastolic relaxation in the early postoperative phase after CPB. Initially, all segments were significantly altered, but by 24 h, regional differences became apparent: LV radial wall motion was recovered, while longitudinal fibers in LV and RV appeared to be less resilient. RV myocardial mechanics were most abnormal. Tissue Doppler analysis may deepen our understanding of myocardial recovery and offers a sensitive tool to compare different cardioprotective strategies.
