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Updated: May 14, 2026
Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography
Published on: October 28, 2020
Disparity in right vs left ventricular recovery during follow-up after ventricular septal defect correction in
Liselotte M Klitsie1, Irene M Kuipers, Arno A W Roest
1Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, Netherlands.
Insights
Pediatric ventricular septal defect (VSD) repair leads to excellent long-term outcomes. While left ventricular function recovers within a year, right ventricular systolic performance remains impaired long after VSD surgery.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Ventricular septal defect (VSD) correction in childhood offers excellent long-term prognosis.
- Post-VSD surgery, transient biventricular systolic dysfunction is often observed in pediatric patients.
- Understanding the temporal dynamics of this systolic performance decrease is crucial for patient management.
Purpose of the Study:
- To characterize biventricular systolic performance following VSD closure in pediatric patients.
- To assess the time-course of systolic performance changes up to 20 months postoperatively.
- To identify potential factors contributing to persistent right ventricular impairment.
Main Methods:
- Echocardiographic assessment of left (LV) and right ventricular (RV) systolic performance in 39 children post-VSD surgery and 22 controls.
- Measurements included LV fractional shortening, tricuspid annular plane systolic excursion (TAPSE), and tissue Doppler imaging (S').
- Evaluations were conducted preoperatively, 1 day postoperatively, at discharge, and 3-20 months postoperatively.
Main Results:
- Biventricular systolic performance initially decreased but showed significant recovery within the first year post-VSD surgery.
- LV systolic performance normalized by medium-term follow-up (8.4 ± 5.3 months).
- RV systolic performance parameters (TAPSE, RV S') remained significantly impaired compared to controls at medium-term follow-up.
Conclusions:
- LV systolic function normalizes within one year after VSD correction.
- RV systolic performance remains significantly impaired up to 20 months post-VSD closure.
- Both cardiopulmonary bypass effects and preoperative conditions may contribute to persistent RV dysfunction post-VSD surgery.
Objectives:
Long-term prognosis after ventricular septal defect (VSD) correction in childhood is excellent. Nevertheless, decreased biventricular systolic performance has been described immediately following VSD surgery in children. In an effort to better understand this decrease and its time-course, we characterized biventricular systolic performance following VSD closure in paediatric patients up to 20 months postoperatively.
Methods:
Thirty-nine children undergoing VSD surgery and 22 age-matched controls were included for echocardiographic follow-up of left (LV) and right ventricular (RV) systolic performance. LV fractional shortening and tricuspid annular plane systolic excursion (TAPSE) were assessed. Additionally, tissue Doppler imaging measurements were obtained at the basal LV lateral wall and RV free wall to assess both LV and RV systolic (S(')) performance. Studies were performed preoperatively, 1 day postoperatively, at discharge and 3-20 months postoperatively at medium-term follow-up.
Results:
After an initial decrease in biventricular systolic performance, a significant recovery was observed within the first year after VSD surgery. After a medium-term follow-up of 8.4 ± 5.3 months, LV systolic performance parameters were normalized, while RV systolic performance parameters remained impaired in patients vs controls (TAPSE: 12.5 ± 1.2 vs 18.5 ± 3.2 mm, RV S('):8.9 ± 1.3 vs 12.5 ± 2.2 cm/s).
Conclusions:
Within the first year after VSD correction, LV systolic performance had normalized, while RV systolic performance remained significantly impaired up to 20 months after VSD closure. Both detrimental effects of open heart surgery with cardiopulmonary bypass and preoperative alterations may add to the observed postoperative impairment of specifically RV performance.
