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Left Atrium Function Study Affection and Myocardial Deformations before and after Ventricular Septal Defect Surgical
Sahar S Sheta1, Mohamed Samir1, Mohamed Eltoukhy1
1Department of Pediatric Cardiology, Faculty of Medicine, Cairo University, Cairo University Specialized Children's Hospital, Cairo, Egypt.
Insights
Surgical closure of ventricular septal defect (VSD) improves patient weight and body surface area. Post-surgery, left atrial function and left ventricular volumes decrease, indicating improved diastolic function but altered systolic mechanics.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Echocardiography
Background:
- Ventricular septal defect (VSD) is a common congenital heart disease (CHD) with potential complications like heart failure.
- Assessing cardiac function pre- and post-surgery is crucial for VSD management.
- Left atrial (LA) function is vital for left ventricular filling and overall cardiac physiology.
Purpose of the Study:
- To validate changes in left atrial (LA) function and myocardial deformation after surgical VSD closure.
- To assess the impact of VSD closure on cardiac function using speckle-tracking echocardiography.
Main Methods:
- A prospective observational study involving 40 VSD patients.
- Paired comparisons of cardiac function assessments preoperatively and 3 months postoperatively.
- Utilized speckle-tracking echocardiography to evaluate LA function and myocardial deformation.
Main Results:
- Post-VSD closure, patients showed significant increases in weight and body surface area.
- LA reservoir, conduit, and contractile strain decreased post-surgery.
- Diastolic function improved (decreased E/E' and MV E/A ratios, increased deceleration time).
- Left ventricular volumes and ejection fraction decreased post-surgery, while right ventricular volumes increased.
- Global longitudinal strain of the left ventricle significantly decreased postoperatively.
Conclusions:
- Preoperative VSD cases exhibited higher LA reservoir, conduit, and contractile function compared to postoperative cases.
- Surgical VSD closure leads to significant alterations in LA and LV function, alongside improved diastolic function.
Background:
Ventricular septal defect (VSD) is the most prevalent form of congenital heart disease (CHD) in children and the second-most prevalent form of CHD in adults, following a bicuspid aortic valve. Large VSDs can lead to significant complications, including heart failure and ventricular dysfunction. Assessing cardiac function in patients with VSD is an essential component of clinical evaluation both before and following surgery. The left atrium (LA) is a critical structure in cardiac physiology, serving as a dynamic chamber that plays a pivotal role in left ventricular filling by actively contributing during various phases of the cardiac cycle through its mechanical functions. Our aim is to validate alterations in LA function and myocardial deformation before and after surgical closure of VSD using speckle-tracking echocardiography.
Patients And Methods:
A prospective observational study with paired comparisons included 40 VSD patients who were assessed preoperatively and had short-term follow-up after 3 months at a tertiary university-based pediatric hospital.
Results:
Infants with hemodynamically significant VSD show impaired growth. Postsurgery, VSD cases demonstrated a significant elevation in weight and body surface area (P < 0.001). LA function assessment with speckle-tracking echocardiography showed a decrease in LA reservoir, LA conduit (CD), and LA contractile (CT) strain (P < 0.001, P = 0.026 and < 0.001, respectively). VSD cases showed that E/E' and MV E/A ratios decreased postsurgery (P < 0.001 and 0.045), whereas deceleration time increased (P < 0.001), indicating improved diastolic dysfunction. VSD cases showed a systolic function decline in septal S' (P = 0.034), and both two-dimensional (2D) and 3D echocardiography revealed significant drops in left ventricle (LV) volumes, whereas 3D echocardiography showed decreased ejection fraction postsurgery (P < 0.024 and P < 0.001, respectively). LV global longitudinal strain significantly decreased postoperatively (P < 0.001). Both left ventricular end-diastolic diameter and left ventricle end diastolic volume (LVEDV) by 2D and 3D LVEDV and LV end-systolic volume decreased significantly with surgery by 2D and 3D (P < 0.05). Right ventricle (RV) volumes by 3D conversely increased postoperatively as 3D right ventricle end diastolic volume (RVEDV) and right ventricle end systolic volume (RVESD) increased (P = 0.003 and 0.002, respectively).
Conclusion:
Preoperative VSD cases demonstrated higher LA R, CD, and CT function compared to postoperative cases.
