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Updated: Oct 24, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Clinical implication of intraoperative ventricular-arterial coupling in pediatric patients undergoing ventricular
Jimi Oh1, Byungdoo Andrew Lee2, Won-Jung Shin2
1Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
Insights
Intraoperative ventricular-arterial coupling (VAC) measured via transesophageal echocardiography in pediatric VSD repair patients increased post-bypass. High postoperative VAC independently predicts worse outcomes, including longer ventilation and hospital stays.
Area of Science:
- Cardiovascular Physiology
- Pediatric Cardiac Surgery
- Echocardiography
Background:
- Ventricular-arterial coupling (VAC) quantifies the efficiency of energy transfer between the left ventricle and the arterial system.
- It is defined as the ratio of arterial elastance (Ea) to ventricular end-systolic elastance (Ees).
Purpose of the Study:
- To assess the clinical implications of intraoperative ventricular-arterial coupling (VAC) in pediatric patients undergoing ventricular septal defect (VSD) repair.
- To evaluate the utility of transesophageal echocardiography (TEE) in deriving VAC from the pressure-area relationship.
Main Methods:
- Retrospective review of 72 pediatric patients with VSDs undergoing corrective surgery with cardiopulmonary bypass.
- Assessment of VAC using the single-beat modified method derived from intraoperative TEE.
- Logistic regression analysis to correlate VAC with postoperative outcomes (vasoactive-inotropic score, ventilation duration, hospital stay).
Main Results:
- Ventricular-arterial coupling (VAC) significantly increased post-cardiopulmonary bypass (1.0 ± 0.4 to 1.4 ± 0.8, p < .001).
- This increase was driven by a disproportionate rise in arterial elastance (Ea) compared to ventricular end-systolic elastance (Ees).
- High postoperative VAC was independently associated with higher vasoactive-inotropic scores (OR, 8.04), longer mechanical ventilation (OR, 11.00), and longer hospital stays (OR, 2.98).
Conclusions:
- Intraoperative TEE provides an accessible method for calculating ventricular-arterial coupling (VAC) in pediatric VSD repair.
- Elevated postoperative VAC is a significant predictor of adverse early outcomes in this patient population.
- VAC serves as a promising intraoperative tool for assessing cardiovascular performance and guiding treatment strategies.
Background:
Ventricular-arterial coupling is the ratio of arterial elastance to ventricular end-systolic elastance.
Aims:
The objective of this study was to determine the clinical implication of intraoperative ventricular-arterial coupling derived from the pressure-area relationship using transesophageal echocardiography.
Methods:
This retrospective study reviewed the medical records of 72 pediatric patients with ventricular septal defects who underwent corrective surgery with cardiopulmonary bypass. The single-beat modified method was used to assess ventricular-arterial coupling. Logistic regression analyses were performed to determine the correlation between ventricular-arterial coupling and early postoperative outcomes, including the maximum vasoactive-inotropic score, length of mechanical ventilation, and length of hospital stay.
Results:
Ventricular-arterial coupling after cardiopulmonary bypass significantly increased (from 1.0 ± 0.4 to 1.4 ± 0.8, p < .001), indicating a disproportionate increase in the arterial elastance index (from 11.5 ± 5.1 to 19.8 ± 7.5 mmHg/cm2 /m2 , p < .001) compared with the ventricular end-systolic elastance index (from 13.0 ± 6.9 to 16.9 ± 9.0 mmHg/cm2 /m2 , p < .001). Logistic regression analyses revealed that high postoperative ventricular-arterial coupling was independently associated with higher postoperative maximum vasoactive-inotropic score (>10; odds ratio [OR], 8.04; 95% confidence interval [CI], 1.38-46.85, p = .020), longer postoperative mechanical ventilation (>15 h; OR: 11.00; 95% CI: 1.26-96.45, p = .030), and longer postoperative hospital stay (>7 days; OR: 2.98; 95% CI: 1.04-8.58, p = .043).
Conclusions:
Ventricular-arterial coupling can be easily obtained from the intraoperative transesophageal echocardiography in pediatric patients undergoing ventricular septal defects repair. High postoperative ventricular-arterial coupling is strongly associated with worse early postoperative outcomes. Ventricular-arterial coupling shows promise as an intraoperative analysis tool that can provide insight into the impact of interventions on cardiovascular performance and identify potential targets for treatment in this population.
