Related Experiment Video
Updated: Jun 18, 2026
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Left ventricular mechanical synchrony and global systolic function in pediatric patients late after ventricular
Surendranath Reddy Veeram Reddy1, Wei Du, Mark V Zilberman
1Children's Hospital of Michigan, Division of Cardiology, The Carmen and Ann Adams Department of Pediatrics, Detroit, MI 48201, USA.
Insights
Pediatric patients after ventricular septal defect (VSD) repair show normal left ventricular (LV) function long-term. However, right bundle branch block (RBBB) after VSD surgery can cause LV mechanical dyssynchrony.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Echocardiography
Background:
- Large ventricular septal defects (VSDs) are surgically repaired in infancy.
- Long-term effects of VSD repair on left ventricular (LV) function and synchrony are not fully understood.
- Postoperative right bundle branch block (RBBB) is a common complication.
Purpose of the Study:
- To evaluate the long-term impact of VSD patch closure and RBBB on LV mechanical synchrony and systolic function.
- Assess pediatric patients over 5 years post-VSD repair.
- Investigate the relationship between RBBB and LV dyssynchrony.
Main Methods:
- Comparison of 18 VSD repair patients with 18 controls using ECG and 3D echocardiography.
- Calculation of LV end-diastolic volumes (LVEDVs) and ejection fraction (EF).
- Assessment of LV intraventricular synchrony using a volumetric dyssynchrony index.
Main Results:
- No significant difference in LVEDV or EF between VSD repair and control groups.
- Overall LV dyssynchrony index was similar between groups (P = .16).
- Patients with RBBB (44%) showed significantly greater LV mechanical dyssynchrony compared to those without RBBB (P = .006).
Conclusions:
- Pediatric patients exhibit normal LV function 5-10 years after VSD patch closure.
- RBBB is associated with increased LV mechanical dyssynchrony and a trend toward LV dilatation.
- Long-term follow-up is recommended for VSD repair patients, especially those with RBBB.
Background:
Patients with large ventricular septal defects (VSDs) undergo surgical patch closure during infancy. The long-term effects of the presence of akinetic patch in the ventricular septum and postoperative right bundle branch block (RBBB) on the left ventricular (LV) mechanical synchrony and global systolic function have not been studied.
Objective:
The objective of this study was to evaluate the long-term effects of an akinetic VSD patch and RBBB on the LV mechanical synchrony and global systolic function in pediatric patients more than 5 years after surgery.
Methods:
Eighteen asymptomatic VSD repair and 18 normal control patients were evaluated by an electrocardiogram and three-dimensional echocardiography. Left ventricular end-diastolic volumes (LVEDVs) and volumetric ejection fraction (EF) were calculated. Left ventricular intraventricular synchrony was assessed by the 16-segment volumetric dyssynchrony index.
Results:
Eight of 18 (44%) patients in the VSD repair group had RBBB. The LVEDV and volumetric EF were similar in the VSD repair and control groups. The LV dyssynchrony index was not significantly different between the VSD repair and control groups (2.46 +/- 1.77% vs. 1.75 +/- 1.08%, P = .16). The VSD repair group was then divided into two subgroups: patients with RBBB (8/18) and those without RBBB (10/18). The two subgroups were similar in demographics, LVEDV, and volumetric EF. However, the RBBB subgroup demonstrated significant LV mechanical dyssynchrony compared with the non-RBBB VSD subgroup (2.70 +/- 1.08% vs. 1.15 +/- 0.35%, P = .006).
Conclusions:
Pediatric patients 5-10 years after VSD patch closure have a normal LV function. The presence of the RBBB causes some mechanical dyssynchrony and tendency toward LV dilatation in this group of patients. Therefore, long-term follow-up of these patients is warranted.
