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Impact of mitral regurgitation on left ventricular remodeling and function in children with rheumatic heart disease

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Abstract

The impact of mitral regurgitation (MR) from pediatric rheumatic heart disease (RHD) and its effect on left ventricular (LV) remodeling and function following surgical intervention is uncertain. The objective is to explore the impact of mitral valve (MV) surgeries on myocardial mechanics, remodeling and function and identify pre-operative predictors of post-operative dysfunction which may contribute to the optimal timing of intervention. A retrospective review of echocardiographic data was performed of eighteen pediatric patients with RHD (median 9yrs, IQR 6–12) who underwent MV surgery. Echocardiograms pre-operatively and a median of 13.5 months (IQR 10.2–15) following intervention were compared to controls. Pre-operative LV end-diastolic indexed volumes (LVEDVi) were significantly increased compared to controls and remained persistently larger post-operatively. LV ejection fraction (LVEF) (pre 62.6% ± 6.1, post 51.7% ± 9.7, p = 0.002), and global longitudinal strain (GLS) (pre − 24.3 ± 4.1, post − 18.2 ± 2.6, p < 0.001) decreased post-operatively at mid-term follow-up. Pre-operative LVEDVi was a significant predictor of post-operative LVEF, with a cut-off of ≥ 102 ml/m2 associated with LV dysfunction (LVEF < 55%; sensitivity 70%, specificity 75%). Pre-operative LVEDVi also negatively correlated with GLS (r = − 0.58, p = 0.01). LV dimensions and volumes remain persistently larger than controls while LV function decreases post-surgical alleviation of MR in paediatric RHD. Pre-operative LVEDVi predicted post-operative LV dysfunction and utilising LV indexed volumes in directing timing of surgical planning should be considered. Further studies are required to investigate whether timely alleviation of MR before significant LV dilatation and remodeling occur may substantially prevent LV dysfunction and improve outcomes.

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Authors and Affiliations

  1. Department of Paediatric Cardiology, Children’s Cardiac Centre, Perth Children’s Hospital, Perth, WA, 6009, Australia

    Adrian J. Tarca, Louise E. Causer, Katie L. Maslin, James M. Ramsay, Bradley R. MacDonald, James P. Little, Prasanthy Hamsanathan & Deane L. Yim

  2. Department of Cardiothoracic Surgery, Children’s Cardiac Centre, Perth Children’s Hospital, Perth, Australia

    David R. Andrews

  3. Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, ON, Canada

    Mark K. Friedberg

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  1. Adrian J. Tarca
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Correspondence to Deane L. Yim.

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The authors disclose no conflict of interest financial or otherwise. This research and manuscript preparation did not receive any specific grants or other support from funding agencies in the public, commercial, or not-for-profit sectors.

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Ethical approval for this study was granted by the Child and Adolescent Health Service Human Research Ethics Committee (PRN: RGS0000003471).

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Tarca, A.J., Causer, L.E., Maslin, K.L. et al. Impact of mitral regurgitation on left ventricular remodeling and function in children with rheumatic heart disease. Int J Cardiovasc Imaging 38, 2667–2676 (2022). https://doi.org/10.1007/s10554-022-02678-w

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