Advertisement

Pediatric Cardiology

, Volume 34, Issue 6, pp 1335–1343 | Cite as

Echocardiographic Predictors of Early Postsurgical Myocardial Dysfunction in Pediatric Patients With Aortic Valve Insufficiency

  • Alexander Lowenthal
  • Theresa A. Tacy
  • Fariborz Behzadian
  • Rajesh PunnEmail author
Original Article

Abstract

In chronic aortic insufficiency (AI), left-ventricular (LV) dysfunction must be detected early to allow timely surgery. Strain and strain rate have been used for this purpose in adults, but the value of this method in pediatric AI has not been established. Forty patients with moderate to severe AI were included in this retrospective study. LV function was assessed by strain analysis and conventional echocardiography both before and after surgery. Of the 32 patients with preserved preoperative ejection fraction (EF; >50 %), 8 had postoperative dysfunction (<50 %). Mean conventional indices of global LV systolic performance for the entire cohort of patients with AI were predominantly in the normal range before surgery. Preoperative values for LV global longitudinal strain (GLS) and strain rate (GLSr) were normal. After surgery, there was a significant decrease in shortening and EF. There was a significant decrease from preoperative to postoperative values for both GLS (–16.07 ± 3.82 vs. –11.06 ± 3.88; p < 0.0001) and GLSr (–0.89 ± 0.24 vs. –0.72 ± 0.27; p = 0.0021). A preoperative GLS of –15.3  (AUC = 0.83, CI = 0.69–0.98, p < 0.0001) and a GLSr of –0.79/s (AUC = 0.86, CI = 0.73–0.98, p < 0.0001) were determined to be predictors of early postoperative dysfunction after surgical repair of moderate to severe AI. A preoperative GLS value of ≤–15.3  and GLSr value of –0.79/s or less are predictors of postoperative ventricular dysfunction, which is defined by EF <50 %. GLS and GLSr value determination may be useful as part of the echocardiographic assessment AI and may help determine the optimal timing of surgery in pediatric patient with at least moderate AI.

Keywords

Aortic regurgitation Echocardiography Strain Surgery 

Notes

Conflict of interest

None

References

  1. 1.
    Bekeredjian R, Grayburn PA (2005) Valvular heart disease: aortic regurgitation. Circulation 112(1):125–134PubMedCrossRefGoogle Scholar
  2. 2.
    Bonow RO, Picone AL, McIntosh CL, Jones M, Rosing DR, Maron BJ et al (1985) Survival and functional results after valve replacement for aortic regurgitation from 1976 to 1983: Impact of preoperative left ventricular function. Circulation 72(6):1244–1256PubMedCrossRefGoogle Scholar
  3. 3.
    Bonow RO, Carabello BA, Kanu C, de Leon AC, Jr Faxon DP, Freed MD et al (2006) ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation 114(5):e84–e231PubMedCrossRefGoogle Scholar
  4. 4.
    Carasso S, Cohen O, Mutlak D, Adler Z, Lessick J, Reisner SA et al (2009) Differential effects of afterload on left ventricular long- and short-axis function: insights from a clinical model of patients with aortic valve stenosis undergoing aortic valve replacement. Am Heart J 158(4):540–545PubMedCrossRefGoogle Scholar
  5. 5.
    Chaliki HP, Mohty D, Avierinos JF, Scott CG, Schaff HV, Tajik AJ et al (2002) Outcomes after aortic valve replacement in patients with severe aortic regurgitation and markedly reduced left ventricular function. Circulation 106(21):2687–2693PubMedCrossRefGoogle Scholar
  6. 6.
    Di Salvo G, Pacileo G, Verrengia M, Rea A, Limongelli G, Caso P et al (2005) Early myocardial abnormalities in asymptomatic patients with severe isolated congenital aortic regurgitation: an ultrasound tissue characterization and strain rate study. J Am Soc Echocardiogr 18(2):122–127PubMedCrossRefGoogle Scholar
  7. 7.
    Fijalkowski M, Koprowski A, Galaska R, Gruchala M, Pawlaczyk R, Brzezinski M et al (2010) Improvement of ultrasonic myocardial properties after aortic valve replacement for pure severe aortic stenosis: the predictive value of ultrasonic tissue characterization for left ventricle reverse remodeling. J Am Soc Echocardiogr 23(10):1060–1066PubMedCrossRefGoogle Scholar
  8. 8.
    Goebel B, Poerner T, Gorenflo M, Lauten A, Jung C, Grohmann J et al (2010) Regional myocardial function in children with chronic aortic regurgitation. Echocardiography 27(8):1021–1027PubMedCrossRefGoogle Scholar
  9. 9.
    Goldbarg SH, Halperin JL (2008) Aortic regurgitation: disease progression and management. Nat Clin Pract Cardiovasc Med 5(5):269–279PubMedCrossRefGoogle Scholar
  10. 10.
    Helin LM, Tamas E, Nylander E (2010) Preoperative longitudinal left ventricular function by tissue Doppler echocardiography at rest and during exercise is valuable in timing of aortic valve surgery in male aortic regurgitation patients. J Am Soc Echocardiogr 23(4):387–395PubMedCrossRefGoogle Scholar
  11. 11.
    Marciniak A, Sutherland GR, Marciniak M, Claus P, Bijnens B, Jahangiri M (2009) Myocardial deformation abnormalities in patients with aortic regurgitation: a strain rate imaging study. Eur J Echocardiogr 10(1):112–119PubMedCrossRefGoogle Scholar
  12. 12.
    Olsen NT, Sogaard P, Larsson HB, Goetze JP, Jons C, Mogelvang R et al (2011) Speckle-tracking echocardiography for predicting outcome in chronic aortic regurgitation during conservative management and after surgery. JACC Cardiovasc Imaging 4(3):223–230PubMedCrossRefGoogle Scholar
  13. 13.
    Onishi T, Kawai H, Tatsumi K, Kataoka T, Sugiyama D, Tanaka H et al (2010) Preoperative systolic strain rate predicts postoperative left ventricular dysfunction in patients with chronic aortic regurgitation. Circ Cardiovasc Imaging 3(2):134–141PubMedCrossRefGoogle Scholar
  14. 14.
    Pettersen MD, Du W, Skeens ME, Humes RA (2008) Regression equations for calculation of z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: an echocardiographic study. J Am Soc Echocardiogr 21(8):922–934PubMedCrossRefGoogle Scholar
  15. 15.
    Pomerantz BJ, Wollmuth JR, Krock MD, Cupps BP, Moustakidis P, Kouchoukos NT et al (2005) Myocardial systolic strain is decreased after aortic valve replacement in patients with aortic insufficiency. Ann Thorac Surg 80(6):2186–2192PubMedCrossRefGoogle Scholar
  16. 16.
    Tornos P, Sambola A, Permanyer-Miralda G, Evangelista A, Gomez Z, Soler-Soler J (2006) Long-term outcome of surgically treated aortic regurgitation: influence of guideline adherence toward early surgery. J Am Coll Cardiol 47(5):1012–1017PubMedCrossRefGoogle Scholar
  17. 17.
    Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G et al (2007) Guidelines on the management of valvular heart disease: the Task force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J 28(2):230–268PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Alexander Lowenthal
    • 1
  • Theresa A. Tacy
    • 1
  • Fariborz Behzadian
    • 1
  • Rajesh Punn
    • 1
    Email author
  1. 1.Echocardiography Laboratory, Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children’s HospitalStanford UniversityPalo AltoUSA

Personalised recommendations