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Right ventricular wall-motion changes after infant open heart surgery--a tissue Doppler study
Linda B Pauliks1, Lilliam M Valdes-Cruz, Richard Perryman
1Pediatric Cardiology, Penn State Hershey Medical College, Hershey, Pennsylvania.
Insights
Tissue Doppler echocardiography (TDI) revealed significant right ventricular (RV) dysfunction after cardiopulmonary bypass (CPB) in infants and neonates, persisting post-discharge. This sensitive tool monitors infant heart function post-CPB.
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Cardiac Surgery
Background:
- Right ventricular (RV) dysfunction is a known complication of cardiopulmonary bypass (CPB) surgery.
- Infants and neonates are at high risk due to immature myocardium.
- Conventional RV function assessment is qualitative; novel tissue Doppler echocardiographic (TDI) markers offer quantitative insights.
Purpose of the Study:
- To assess myocardial velocities, isovolumic contraction acceleration (IVA), and strain rate (SR) in infants and neonates undergoing open heart surgery using TDI.
- To evaluate regional myocardial function perioperatively in this vulnerable population.
Main Methods:
- Transthoracic TDI data were collected from 53 infants before and 24 hours after CPB.
- Measurements included peak systolic and diastolic myocardial velocities, IVA, and peak SR in both RV and left ventricle (LV).
- Patients were followed with TDI through hospital discharge.
Main Results:
- Postoperatively, LV systolic and diastolic function remained stable or improved.
- LV radial velocities increased, indicating adequate support.
- Significant RV longitudinal systolic and diastolic function impairment was observed after CPB, persisting through discharge.
Conclusions:
- Perioperative TDI parameter measurement is feasible in infants and neonates.
- TDI revealed significant RV systolic and diastolic dysfunction post-CPB, with preserved LV function.
- TDI is a sensitive tool for monitoring infant heart function after CPB and may aid in assessing myocardial protection strategies.
Background:
Right ventricular (RV) dysfunction is a well-recognized complication of cardiopulmonary bypass surgery (CPB) in adults. Infants and neonates may also be at high risk for this due to immature myocardium. Conventional assessment of RV function is just qualitative, but novel tissue Doppler echocardiographic (TDI) markers including peak systolic strain rate (SR) and isovolumic contraction acceleration (IVA) permit noninvasive quantitation of RV function. This study assessed myocardial velocities, IVA and SR in infants and neonates undergoing open heart surgery using TDI to study regional myocardial function perioperatively.
Methods:
Transthoracic TDI data were obtained in the OR before and 24 hours post-CPB on 53 consecutive infants (age 0.39 ± 0.23 years). They were followed with TDI through hospital discharge.
Results:
Mean CPB time was 87 ± 49 min (cross-clamp 52 ± 26 min). Peak systolic (STDI ) and diastolic myocardial velocities (ETDI , ATDI ), IVA, and peak SR were recorded in RV and LV from standard views for offline analysis. Postoperatively, LV systolic function and diastolic longitudinal function were unchanged or improved from baseline. LV radial velocities were increased postoperatively indicating adequate support. In contrast, RV longitudinal systolic and diastolic function was significantly diminished after CPB. RV changes persisted through hospital discharge.
Conclusions:
In infants and neonates, perioperative measurements of systolic and diastolic tissue Doppler parameters are feasible and revealed significant RV systolic and diastolic dysfunction post-CPB with preserved LV function. As such, TDI provides a sensitive tool to monitor the infant heart after CPB and may potentially be useful to assess different myocardial protection strategies.
