Right ventricular wall-motion changes after infant open heart surgery--a tissue Doppler study

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.