Left ventricular function after arterial switch operation as assessed by two-dimensional speckle-tracking echocardiography in patients with simple transposition of the great arteries

Background: The late postoperative course for children with transposition of the great arteries [TGA] with an intact ventricular septum [IVS] is very important because the coronary arteries may be at risk of damage during arterial switch operation [ASO]. We sought to investigate left ventricular function in patients with TGA/IVS by echocardiography

Methods: From March 2011 to December 2012, totally 20 infants [12 males and 8 females] with TGA/IVS were evaluated via 2-dimensional speckle-tracking echocardiography [2D STE] more than 6 months after they underwent ASO. A control group of age-matched infants and children was also studied. Left ventricular longitudinal strain [S], strain rate [SR], time to peak systolic longitudinal strain [TPS], and time to peak systolic longitudinal strain rate [TPSR] were measured and compared between the 2 groups

Results: Mean +/- SD of age at the time of study in the patients with TGA/IVS was 15 +/- 5 months, and also age at the time of ASO was 12 +/- 3 days. Weight was 3.13 +/- 0.07 kg at birth and 8.83 +/- 1.57 kg at the time of ASO. Global strain [S], Time to peak strain rate [TPSR], and Time to peak strain [TPS] were not significantly different between the 2 groups, whereas global strain rate [SR] was significantly different [p value < 0.001]. In the 3-chamber view, the values of S in the lateral, septal, inferior, and anteroseptal walls were significantly different between the 2 groups [p value < 0.001], and SR in the posterior wall was significantly different between the 2 groups [p value < 0.001]. There were no positive correlations between S and SR in terms of the variables of heart rate, total cardiopulmonary bypass time, and aortic cross-clamp time. There were no statistically significant differences between the 2 groups regarding S, SR, TPS, and TPSR in the anteroseptal and posterior walls in the 3-chamber view and in the lateral and septal walls in the 4-chamber view

Conclusion: We showed that between 6 and 18 months after a successful ASO, the parameters of S, SR, and global TPS were normal in our patients with TGA/IVS. However, LV myocardial TPSR did not normalize in this time period

novel method for quantification of left ventricular noncompaction using two-dimensional echocardiography in children

Although there are several echocardiographic criteria, there is not yet a general consensus about the diagnosis of left ventricular noncompaction. The current criteria are mostly based on the areas with maximal noncompaction in the heart The echocardiographer may miss this maximal point leading to a misdiagnosis. Accordingly, we suggested a new method to measure the percentage of myocardial noncompaction using two-dimensional echocardiography. In this study, the new method was examined on 4 noncompaction and 26 dilated cardiomyopathies, and 25 normal subjects. The percentage of noncompaction was measured at 3 levels [apical, papillary muscle and mitral valve] and averaged. The mean percentages of myocardial noncompaction were 3.59 +/- 2.27, 8.86 +/- 5.52 and 34.7 +/- 26.1 in the control, dilated cardiomyopathy and noncompaction groups, respectively. A value of 17% or greater could distinguish left ventricular noncompaction from dilated cardiomyopathy with 92% specificity and 100% sensitivity and from normal subjects with 100% specificity and sensitivity. This percentage had a statistically significant association with noncompacted to compacted myocardial thickness ratio [P<0.001]. This method showed good correlations with the existing echocardiographic and magnetic resonance criteria. However, it is not dependent on finding the area of maximal involvement Being comparable to magnetic resonance imaging in accuracy, it is easier to perform and more available

Correlation between qrs duration, pulmonary insufficiency and right ventricle performance in totally corrected tetralogy of fallot

Despite progresses in surgical correction of Tetralogy of Fallot, pulmonary insufficiency and progressive dysfunction of the right ventricle impress its long-term prognosis. In this study we examined the correlations between QRS duration, pulmonary insufficiency and right ventricular performance index. We enrolled 57 repaired Tetralogy of Fallot patients. QRS duration on electrocardiogram, pulmonary regurgitation index [regurgitation time to diastolic time ratio], and right ventricular myocardial performance index were measured. There was a strong inverse correlation between QRS duration and pulmonary regurgitation index. However, significant correlation did not exist between QRS duration and right ventricular myocardial performance index. QRS duration >160 ms predicted severe pulmonary regurgitation with 100% sensitivity and 87% specificity. Increased QRS duration can predict severity of pulmonary regurgitation

Efficiency, sensitivity and specificity of automated auscultation diagnosis device for detection and discrimination of cardiac murmurs in children

Intelligent electronic stethoscopes and computer-aided auscultation systems have highlighted a new era in cardiac auscultation in children. Several collaborative multidisciplinary researches in this field are performed by physicians and computer specialists. Recently, a novel medical software device, Automated Auscultation Diagnosis Device [AADD], has been reported with intelligent diagnosing ability to differentiate cardiac murmur from breath sounds in children with normal and abnormal hearts due to congenital heart disease. The aim of this study is to determine efficiency, sensitivity and specificity of the diagnoses made by this AADD in children with and without cardiac disease. We performed a cross-sectional study to determine efficiency, sensitivity and specificity of diagnoses made by AADD. Our patient population was two groups of children with and without cardiac disease [563 patients and 50 normal]. SPSS version 16 was used to calculate sensitivity, specificity and efficiency and descriptive analysis. Using cardiac sound recording in four conventional cardiac areas of auscultation [including aortic, pulmonary, tricuspid and mitral], AADD proved to have a >/= 90% sensitivity, specificity and efficiency for making the correct diagnosis in children with heart disease and 100% diagnostic accuracy in children with normal hearts either with or without innocent murmurs. Considering the high sensitivity, specificity and efficiency of AADD for making the correct diagnosis, application of this software is recommended for family physicians to enhance proper and timely patients' referral to pediatric cardiologists in order to provide better diagnostic facilities for pediatric patients who live in deprived and underserved rural areas with lack access to pediatric cardiologists

Right ventricular myocardial tissue velocities, myocardial performance index, and tricuspid annular plane systolic excursion in totally corrected tetralogy of Fallot patients

Longer survival after the total repair of the Tetralogy of Fallot increases the importance of late complications such as right ventricular dysfunction. This is a prospective study of the right ventricular function in totally corrected Tetralogy of Fallot patients versus healthy children. Thirty-two healthy children were prospectively compared with 30 totally corrected Tetralogy of Fallot patients. Right ventricular myocardial tissue velocities, right ventricular myocardial performance index, and tricuspid annular plane systolic excursion were investigated as well as the presence and severity of pulmonary regurgitation. The two groups were age-and sex-matched. Mean systolic peak velocity [Sa] and tricuspid annular plane systolic excursion were significantly decreased, while myocardial performance index and early to late diastolic velocity [Ea/Aa] were significantly increased in the Tetralogy of Fallot patients. Early diastolic velocity [Ea] showed no significant difference between the two groups. Sa correlated significantly with tricuspid annular plane systolic excursion in both the normal children and totally corrected Tetralogy of Fallot patients. Myocardial performance index was significantly higher in the patients with moderate to severe pulmonary regurgitation than in those with mild regurgitation. However, there was no significant correlation between this index and right ventricular myocardial tissue velocities. In this study, systolic right ventricular function indices [Sa and tricuspid annular plane systolic excursion] were impaired in the totally corrected Tetralogy of Fallot patients. Myocardial performance index was affected by the severity of pulmonary regurgitation

Assessment of left atrial ejection force in mildly asphyxiated newborns

Asphyxia-induced cardiac insult is one of the major causes of mortality and morbidity in the course of perinatal asphyxia. Nowadays, a remarkable trend of interest is sensed introducing a plausible modality for early detection of cardiac insults at the beginning stages of asphyxia. In this study we aimed to evaluate diagnostic utility of transmitral Doppler-derived parameters as well as left atrial ejection force index as a marker of left atrial contractile function in these patients. In a prospective study selected cases of 26 asphyxiated newborns with preserved systolic function underwent conventional transmitral Doppler flow echocardiographic assessment. Left atrial ejection force index was further calculated for all patients. Data was compared with normal ranges of healthy newborns in order to clarify the diagnostic utility of these parameters for determining minor cardiac insults in this age group. We found that mildly asphyxiated newborns showed an increase in the values of left atrial ejection force index [5.44 +/- 2.12 kilodyne vs. 6.66 +/- 2.17 kilodyne, P= 0.02] and left atrial filling fraction [39% +/- 10% vs. 45% +/- 8%, P= 0.01]. Furthermore, the acceleration and deceleration rate of early filling flow peak velocity were decreased in this group of asphyxiated newborns. Assessment of left atrial ejection force in mildly asphyxiated newborns reveals that newborns with even mild asphyxia, although could not be categorized in conventional grading system, suffer to some extent from a ventricular filling abnormality. This type of latent ventricular filling abnormality could simply be unmasked by calculation of atrial ejection force index

Angiotensin converting enzyme inhibitors and aortic arch obstructive malformations.

We describe two newborn infants with aortic arch obstructive malformations who became anuric after initiation of captopril. Since angiotensin converting enzyme inhibitors can alter renal blood flow by reduction in angiotensin II and blocking autoregulation phenomenon, it is important to use them with great caution in neonates with aortic arch obstructive malformations, while monitoring their renal function closely.