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Faraji E, Bolin EH, Collins Ii RT, Greiten L, Daily JA. Author Response to Letter to the Editor Re: "Left Ventricular Dysfunction Following Repair of Ventricular Septal Defects in Infants". Pediatr Cardiol 2024; 45:1161-1162. [PMID: 38498183 DOI: 10.1007/s00246-024-03474-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 03/20/2024]
Affiliation(s)
- Ehssan Faraji
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Arkansas Children's Hospital, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202-3591, USA
| | - Elijah H Bolin
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Arkansas Children's Hospital, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202-3591, USA
| | - R Thomas Collins Ii
- University of Kentucky College of Medicine, Lexington, KY, USA
- Kentucky Children's Hospital, Lexington, KY, USA
| | - Lawrence Greiten
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Arkansas Children's Hospital, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202-3591, USA
| | - Joshua A Daily
- University of Arkansas for Medical Sciences, Little Rock, AR, USA.
- Arkansas Children's Hospital, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202-3591, USA.
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Faraji E, Bolin EH, Bond EG, Thomas Collins R, Greiten L, Daily JA. Left Ventricular Dysfunction Following Repair of Ventricular Septal Defects in Infants. Pediatr Cardiol 2024:10.1007/s00246-023-03391-8. [PMID: 38236399 DOI: 10.1007/s00246-023-03391-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/20/2023] [Indexed: 01/19/2024]
Abstract
Left ventricular systolic dysfunction (LVSD) is frequently observed following repair of ventricular septal defects (VSD), although little is known about its incidence, time course, or risk factors. Among infants undergoing VSD repair, for postoperative LVSD, we sought to determine (1) incidence, (2) predictors, and (3) time to resolution. We queried our institution's surgical database for infants who underwent repair of isolated VSDs from November 2001 through January 2019. The primary outcome was postoperative LVSD, which was defined as a shortening fraction (SF) of <26% by M-mode. Postoperative echocardiograms were reviewed, and measurements were made using standard methods. Receiver operating characteristic analysis was generated to determine the preoperative left ventricular internal dimension (LVIDd) z-score most predictive of LVSD. Multivariable analysis was conducted to determine associations with LVSD; covariates in the model were weight percentile, genetic syndrome, preoperative diuretic, VSD type, and preoperative LVIDd z-score. Of the 164 patients who met inclusion criteria, 62 (38%) had postoperative LVSD. Fifty-eight (94%) of patients had resolution of LVSD within 9 months of surgery. Preoperative LVIDd z-score of >3.1 was associated with both an increased incidence of postoperative LVSD and prolonged time to resolution. Multivariable logistic regression analysis showed only preoperative LVIDd z-score was independently associated with postoperative LVSD. LVSD following VSD closure is common, but nearly all cases resolve by 9 months postoperatively. Elevated LVIDd prior to surgery is associated with postoperative LVSD. These data suggest VSD closure should be considered prior to the development of significant left ventricular dilation.
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Affiliation(s)
- Ehssan Faraji
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elijah H Bolin
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Arkansas Children's Hospital, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202-3591, USA
| | - Elizabeth G Bond
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - R Thomas Collins
- University of Kentucky College of Medicine, Lexington, KY, USA
- Kentucky Children's Hospital, Lexington, KY, USA
| | - Lawrence Greiten
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Arkansas Children's Hospital, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202-3591, USA
| | - Joshua A Daily
- University of Arkansas for Medical Sciences, Little Rock, AR, USA.
- Arkansas Children's Hospital, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202-3591, USA.
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Reddy CD, Yokota R, Punn R. Tricuspid valve annular tilt for assessment of pre- and post-intervention right ventricular volume in patients undergoing transcatheter pulmonary valve replacement. Cardiol Young 2024; 34:171-177. [PMID: 37309189 DOI: 10.1017/s1047951123001452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Transcatheter pulmonary valve replacement serves as a successful alternative to surgical replacement of a right ventricle to pulmonary artery conduit. Guidelines for recommending transcatheter pulmonary valve replacement depend on MRI right ventricular volumes, which have been correlated to the echocardiographic measure of right ventricular annular tilt. We aim to assess whether right ventricular annular tilt can be a clinically useful alternative tool in the acute and long-term periods after transcatheter pulmonary valve replacement to assess right ventricular health. METHODS We reviewed 70 patients who underwent transcatheter pulmonary valve replacement at a single institution. Echocardiographic measurements were obtained prior to transcatheter pulmonary valve replacement, immediately after transcatheter pulmonary valve replacement, and within 6 months to 1 year after transcatheter pulmonary valve replacement. Right ventricular annular tilt measures the angle of the tricuspid valve plane relative to the mitral valve plane at end-diastole in the apical four-chamber view. Right ventricular fractional area change, right ventricular systolic strain, tissue Doppler velocity, and tricuspid annular plane systolic excursion Z-scores were obtained using published methods. RESULTS Right ventricular annular tilt decreased significantly immediately after transcatheter pulmonary valve replacement (p = 0.0004), and this reduction in right ventricular volume persisted at the mid-term follow-up (p < 0.0001). Fractional area change did not change significantly after transcatheter pulmonary valve replacement while right ventricular global strain improved at mid-term follow-up despite no significant difference immediately after transcatheter pulmonary valve replacement. CONCLUSIONS Right ventricular annular tilt decreases both immediately after transcatheter pulmonary valve replacement and at mid-term follow-up. Right ventricular strain also improved after transcatheter pulmonary valve replacement, corresponding to the improved volume load. Right ventricular annular tilt can be considered as an additional echocardiographic factor to assess right ventricular volume and remodeling after transcatheter pulmonary valve replacement.
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Affiliation(s)
- C D Reddy
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University, Palo Alto, CA, USA
| | - R Yokota
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University, Palo Alto, CA, USA
| | - R Punn
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University, Palo Alto, CA, USA
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Punn R. Is Our Assessment of Ventricular Function Now Twisted? JACC. ADVANCES 2023; 2:100395. [PMID: 38938232 PMCID: PMC11198105 DOI: 10.1016/j.jacadv.2023.100395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Rajesh Punn
- Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, California, USA
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Left Ventricular Systolic Impairment after Pediatric Cardiac Surgery Assessed by STE Analysis. Healthcare (Basel) 2021; 9:healthcare9101338. [PMID: 34683018 PMCID: PMC8544436 DOI: 10.3390/healthcare9101338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/27/2021] [Accepted: 10/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Speckle-tracking echocardiography (STE) has gained increasing value in the evaluation of congenital heart diseases (CHD); however, its use in pediatric cardiac surgery is limited. Aim: To evaluate left ventricular (LV) systolic impairment after biventricular pediatric cardiac surgery by STE strain (ε) analysis. Methods: We prospectively enrolled 117 children undergoing cardiac surgery for CHD. Echocardiography was performed at four different times: pre-operatively, 12–36 h (Time 1), 3–5 days (Time 2), and 6–8 days (Time 3). Images were obtained in the 4-2-and 3 apical chamber’s views to derive LV global and regional (basal/mid/apical) ε values. Results: At different postoperative times, we performed 320 examinations in 117 children (mean age: 2.4 ± 3.9, range: 0–16 years); 117 age-matched healthy children served as controls. All global, basal, and mid LVε values decreased after surgery; the lowest values being at Time 1 (p < 0.0001), which increased thereafter. At discharge, all global, basal, and mid LVε values remained lower than in pre-operative and healthy children (p < 0.05). Instead, apical segments (lowest at baseline) increased after surgery (p < 0.0001) but remained lower compared to controls. LV ejection fraction (LVEF) decreased at Time 1 (p = 0.0004) but promptly recovered to Time 2 and normalized at Time 3. Conclusions: STE ε analysis revealed a significant LV systolic impairment after surgery with amelioration thereafter but incomplete normalization at discharge. Base-apex differences emerged with apical segments that, contrary to all the other regions, showed relative hypercontractility after surgery. The slower recovery of LVε values compared to LVEF suggests that STE ε analysis may be more accurate for the follow-up of mild LV post-surgical impairment.
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Budts W, Miller O, Babu-Narayan SV, Li W, Valsangiacomo Buechel E, Frigiola A, van den Bosch A, Bonello B, Mertens L, Hussain T, Parish V, Habib G, Edvardsen T, Geva T, Roos-Hesselink JW, Hanseus K, Dos Subira L, Baumgartner H, Gatzoulis M, Di Salvo G. Imaging the adult with simple shunt lesions: position paper from the EACVI and the ESC WG on ACHD. Endorsed by AEPC (Association for European Paediatric and Congenital Cardiology). Eur Heart J Cardiovasc Imaging 2021; 22:e58-e70. [PMID: 33338215 DOI: 10.1093/ehjci/jeaa314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/03/2020] [Indexed: 01/08/2023] Open
Abstract
In 2018, the position paper 'Imaging the adult with congenital heart disease: a multimodality imaging approach' was published. The paper highlights, in the first part, the different imaging modalities applied in adult congenital heart disease patients. In the second part, these modalities are discussed more detailed for moderate to complex anatomical defects. Because of the length of the paper, simple lesions were not touched on. However, imaging modalities to use for simple shunt lesions are still poorly known. One is looking for structured recommendations on which they can rely when dealing with an (undiscovered) shunt lesion. This information is lacking for the initial diagnostic process, during repair and at follow-up. Therefore, this paper will focus on atrial septal defect, ventricular septal defect, and persistent arterial duct. Pre-, intra-, and post-procedural imaging techniques will be systematically discussed. This position paper will offer algorithms that might help at a glance. The document is prepared for general cardiologists, trainees, medical students, imagers/technicians to select the most appropriate imaging modality and to detect the requested information for each specific lesion. It might serve as reference to which researchers could refer when setting up a (imaging) study.
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Affiliation(s)
- Werner Budts
- Department Cardiovascular Sciences (KU Leuven), Congenital and Structural Cardiology (CSC UZ Leuven), Herestraat 49, B-3000 Leuven, Belgium
| | - Owen Miller
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Sonya V Babu-Narayan
- Department of Adult Congenital Heart Disease, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | - Wei Li
- Department of Adult Congenital Heart Disease, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | | | - Alessandra Frigiola
- Department of Adult Congenital Heart Disease, Guy's and St Thomas' Hospital and School of Biomedical Engineering and Imaging Sciences, Kings College, London, UK
| | | | - Beatrice Bonello
- Department of Pediatric Cardiology, Great Ormond Street Hospital, London, UK
| | - Luc Mertens
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children and University of Toronto, SickKids, Ontario, Canada
| | - Tarique Hussain
- Department of Paediatrics, University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - Victoria Parish
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
| | - Gilbert Habib
- Cardiology Department, APHM, La Timone Hospital, Boulevard Jean Moulin, Marseille, France
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Laura Dos Subira
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Helmut Baumgartner
- Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Cardiology, Muenster, Germany
| | - Michael Gatzoulis
- Department of Adult Congenital Heart Disease, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | - Giovanni Di Salvo
- Department of Adult Congenital Heart Disease, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
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Sanil Y, Misra A, Safa R, Blake JM, Eddine AC, Balakrishnan P, Garcia RU, Taylor R, Dentel JN, Ang J, Cashen K, Heidemann SM, Bauerfield C, Sethuraman U, Farooqi A, Aggarwal S, Singh G. Echocardiographic Indicators Associated with Adverse Clinical Course and Cardiac Sequelae in Multisystem Inflammatory Syndrome in Children with Coronavirus Disease 2019. J Am Soc Echocardiogr 2021; 34:862-876. [PMID: 33957250 PMCID: PMC8089028 DOI: 10.1016/j.echo.2021.04.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 02/08/2023]
Abstract
Background Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 causes significant cardiovascular involvement, which can be a determinant of clinical course and outcome. The aim of this study was to investigate whether echocardiographic measures of ventricular function were independently associated with adverse clinical course and cardiac sequelae in patients with MIS-C. Methods In a longitudinal observational study of 54 patients with MIS-C (mean age, 6.8 ± 4.4 years; 46% male; 56% African American), measures of ventricular function and morphometry at initial presentation, predischarge, and at a median of 3- and 10-week follow-up were retrospectively analyzed and were compared with those in 108 age- and gender-matched normal control subjects. The magnitude of strain is expressed as an absolute value. Risk stratification for adverse clinical course and outcomes were analyzed among the tertiles of clinical and echocardiographic data using analysis of variance and univariate and multivariate regression. Results Median left ventricular apical four-chamber peak longitudinal strain (LVA4LS) and left ventricular global longitudinal strain (LVGLS) at initial presentation were significantly decreased in patients with MIS-C compared with the normal cohort (16.2% and 15.1% vs 22.3% and 22.0%, respectively, P < .01). Patients in the lowest LVA4LS tertile (<13%) had significantly higher C-reactive protein and high-sensitivity troponin, need for intensive care, and need for mechanical life support as well as longer hospital length of stay compared with those in the highest tertile (>18.5%; P < .01). Initial LVA4LS and LVGLS were normal in 13 of 54 and 10 of 39 patients, respectively. There was no mortality. In multivariate regression, only LVA4LS was associated with both the need for intensive care and length of stay. At median 10-week follow-up to date, seven of 36 patients (19%) and six of 25 patients (24%) had abnormal LVA4LS and LVGLS, respectively. Initial LVA4LS < 16.2% indicated abnormal LVA4LS at follow-up with 100% sensitivity. Conclusion Impaired LVGLS and LVA4LS at initial presentation independently indicate a higher risk for adverse acute clinical course and persistent subclinical left ventricular dysfunction at 10-week follow-up, suggesting that they could be applied to identify higher risk children with MIS-C.
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Affiliation(s)
- Yamuna Sanil
- Department of Pediatrics, Division of Pediatric Cardiology, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Amrit Misra
- Department of Pediatrics, Division of Pediatric Cardiology, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Raya Safa
- Department of Pediatrics, Division of Pediatric Cardiology, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan; Department of Pediatrics, Division of Pediatric Critical Care Medicine, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan; Department of Pediatrics, Division of Pediatric Cardiology, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Jennifer M Blake
- Department of Pediatrics, Division of Pediatric Cardiology, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Ahmad Charaf Eddine
- Department of Pediatrics, Division of Pediatric Cardiology, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Preetha Balakrishnan
- Department of Pediatrics, Division of Pediatric Cardiology, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Richard U Garcia
- Department of Pediatrics, Division of Pediatric Cardiology, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan; Department of Pediatrics, Division of Pediatric Critical Care Medicine, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan; Department of Pediatrics, Division of Pediatric Cardiology, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Rachel Taylor
- Department of Pediatrics, Division of Pediatric Cardiology, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - John N Dentel
- Department of Pediatrics, Division of Pediatric Cardiothoracic Surgery, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Jocelyn Ang
- Department of Pediatrics, Division of Pediatric Infectious Disease, Wayne State University, Children's Hospital of Michigan, Detroit, Michigan; Department of Pediatrics, Division of Pediatric Infectious Disease, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Katherine Cashen
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Sabrina M Heidemann
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Christian Bauerfield
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Usha Sethuraman
- Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Ahmad Farooqi
- Children's Research Center of Michigan, Central Michigan University College of Medicine, Detroit, Michigan
| | - Sanjeev Aggarwal
- Department of Pediatrics, Division of Pediatric Cardiology, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan; Department of Pediatrics, Division of Pediatric Cardiology, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Gautam Singh
- Department of Pediatrics, Division of Pediatric Cardiology, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan.
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