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Myocardial strain in newborn infants with tracheomalacia due to vascular rings, a pilot study
Anna Claudia Massolo1, Flaminia Calzolari1, Marco Cosimo Campanale1
1Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Insights
Infants with vascular rings (VR) causing severe airway obstruction show reduced heart muscle function. This suggests secondary cardiac dysfunction in pediatric patients with VR and tracheomalacia.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Respiratory Medicine
Background:
- Vascular rings (VR) can lead to severe tracheomalacia and upper airway obstruction (UAO) in infants.
- Chronic UAO is linked to increased pulmonary artery pressure and cardiac dysfunction, but this is understudied in VR-associated UAO.
- Evaluating myocardial strain in infants with UAO due to VR is crucial.
Purpose of the Study:
- To assess myocardial strain in infants experiencing upper airway obstruction caused by vascular rings.
- To investigate potential secondary cardiac dysfunction in this pediatric population.
Main Methods:
- Collected data on demographics, respiratory symptoms, tracheal obstruction severity (CT scan), and lung function.
- Measured left (LV) and right ventricle (RV) systolic function using speckle tracking echocardiography longitudinal strain (LS).
- Assessed pulmonary artery pressure via tricuspid regurgitation (TR) and LV end-systolic eccentricity index (EI).
Main Results:
- Fifteen infants were studied; nine had moderate-severe (≥50%) obstruction.
- LV LS and RV LS were significantly reduced in moderate-severe obstruction cases compared to mild cases (p<0.05).
- No significant differences in TR, EI, or lung function were found between groups.
Conclusions:
- Infants with VR-induced severe tracheomalacia exhibit reduced RV and LV myocardial strain.
- This reduction indicates secondary cardiac dysfunction in infants with vascular rings and severe airway obstruction.
Background:
Vascular rings (VR) may cause severe tracheomalacia and upper airway obstruction (UAO). Increased pulmonary artery pressure and cardiac dysfunction have been described in patients with chronic UAO, but has not been investigated in infants with obstruction associated with VR. The aim of this study is to evaluate myocardial strain in infants with UAO due to VR.
Method:
Demographic characteristics, respiratory symptoms, percentage of tracheal obstruction measured and classified using Computer Tomography, and lung function testing (LFT) were collected. Left (LV) and right ventricle (RV) systolic functions were measured using speckle tracking echocardiography longitudinal strain analysis (LS). Pulmonary artery pressure was evaluated using maximal tricuspid regurgitation jet velocity (TR) and LV end-systolic eccentricity index (EI).
Results:
Fifteen cases were included in the study, six had mild tracheal obstruction (<50%), nine moderate-severe obstruction (≥50%). LV LS and RV LS were significantly reduced in cases with moderate to severe airway obstruction cases compared to those with mild airway obstruction (LV LS -15.9 versus -19.9%; RV LS -15.7 versus -20.5%, p = .04 and p = .02, respectively). Respiratory symptoms were more pronounced in moderate-severe cases. No significant differences in TR, EI, and LFT were observed.
Conclusions:
In cases of VR with severe tracheomalacia RV and LV myocardial strain is reduced, suggesting secondary cardiac dysfunction.
