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Pediatric Cardiology

, Volume 35, Issue 3, pp 530–535 | Cite as

Altered Right Ventricular Function in the Long-Term Follow-up Evaluation of Patients After Delayed Aortic Reimplantation of the Anomalous Left Coronary Artery From the Pulmonary Artery

  • Rita Schuck
  • Mohamed Y. Abd El Rahman
  • Axel Rentzsch
  • Wei Hui
  • Yuguo Weng
  • Vladimir Alexi-Meskishvili
  • Peter E. Lange
  • Felix Berger
  • Hashim Abdul-Khaliq
Original Article

Abstract

This study aimed to evaluate regional and global ventricular functions in the long term after aortic reimplantation of the anomalous left coronary artery from the pulmonary artery (ALCAPA) and to assess whether the time of surgical repair influences ventricular performance.The study examined 20 patients with a median age of 15 years (range 3–37 years) who had a corrected ALCAPA and 20 age-matched control subjects using echocardiography and tissue Doppler imaging (TDI). The median follow-up period after corrective surgery was 6 years (range 2.6–15 years). Seven patients underwent surgery before the age of 3 years (early-surgery group), whereas 13 patients had surgery after that age (late-surgery group). The TDI-derived myocardial strain of the interventricular septum (IVS), lateral wall of the left ventricle (LV), and lateral wall of the right ventricle (RV) in the basal and mid regions were examined, and a mean was calculated. The pulsed Doppler-derived Tei index was used to assess global left ventricular function. No significant differences were found between the early-surgery group and the control group regarding the regional myocardial strain or the Tei index. Compared with the early-surgery group, the late-surgery group had a significantly higher Tei index (mean 0.37; range 0.31–0.42 vs. mean 0.52; range 0.39–0.69; p < 0.005), a lower strain percentage of the lateral wall of the LV (mean 29; range 17–30 vs. mean 9; range 7–23), IVS (mean 23; range 21–31 vs. mean 19; range 13–25), and lateral wall of the RV (mean 23; range 21–31 vs. mean 19; range 13–25). The age at operation correlated significantly with the Tei index (r = 0.84, p < 0.001) and inversely with the mean strain of the lateral wall of the LV (r = −0.53, p = 0.028), IVS (r = −0.68, p = 0.003), and lateral wall of the RV (r = −0.68, p = 0.003). At the midterm follow-up evaluation after corrective surgery of ALCAPA, not only the left but also the right ventricular function seemed to be affected in patients with delayed diagnosis and late surgical repair but preserved among the younger patients with early diagnosis and corrective surgery.

Keywords

Aortic reimplantation Ventricular function Anomalous left coronary artery from the pulmonary artery ALCAPA Tissue Doppler imaging (TDI) 

Notes

Acknowledgments

We thank Anne Gale (Deutsches Herzzentrum Berlin) for editorial assistance. This work was supported by the Kompetenznetz Angeborene Herzfehler (Competence Network for Congenital Heart Defects) funded by the Federal Ministry of Education and Research (BMBF), FKZ 01G10210.

Conflict of interest

The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Rita Schuck
    • 1
  • Mohamed Y. Abd El Rahman
    • 1
    • 3
    • 4
  • Axel Rentzsch
    • 1
    • 3
  • Wei Hui
    • 1
    • 5
  • Yuguo Weng
    • 2
  • Vladimir Alexi-Meskishvili
    • 2
  • Peter E. Lange
    • 1
  • Felix Berger
    • 1
  • Hashim Abdul-Khaliq
    • 1
    • 3
  1. 1.Department of Congenital Heart DiseaseDeutsches Herzzentrum Berlin, Charité - Universitaetsmedizin BerlinBerlinGermany
  2. 2.Department of Cardiothoracic and Vascular SurgeryDeutsches Herzzentrum BerlinBerlinGermany
  3. 3.Department of Pediatric CardiologySaarland University HospitalHomburg/SaarGermany
  4. 4.Department of Pediatrics and Pediatric CardiologyCairo UniversityCairoEgypt
  5. 5.Labatt Family Heart Centre Hospital for Sick ChildrenUniversity of TorontoTorontoCanada

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