ABSTRACT
BACKGROUND: Left ventricular (LV) dysfunction may complicate paediatric cardiac surgery with cardiopulmonary bypass, notably after long aortic cross-clamping (ACC). Assessment of occult myocardial injury by conventional echocardiographic variables may be difficult in the postoperative period. AIMS: To evaluate the feasibility of two-dimensional (2D) strain in the postoperative period, and to assess the effect of ACC duration on this variable. METHODS: Thirty-three paediatric patients (age<18years) with congenital heart disease undergoing cardiac surgery with cardiopulmonary bypass were included in this prospective single-centre study. Daily echocardiography was performed from the day before surgery to the fifth postoperative day. LV ejection fraction and LV 2D strain were measured. The cohort was divided into three groups according to ACC duration (group 1:<30minutes; group 2: 30-80minutes; group 3:>80minutes). RESULTS: Mean age and weight were 4.2±2.5years and 15.1±5.2kg, respectively. Feasibilities of longitudinal, circumferential and radial strains were good, and quite similar to conventional variables. Compared with conventional variables, intra- and interobserver agreements regarding 2D strain were better (r=0.916, P<0.001 and r=0.855, P<0.001 for longitudinal strain versus r=0.156, P=0.54 and r=0.064, P=0.80 for LV ejection fraction by Simpson's method). Postoperative evolution of longitudinal and circumferential strains was significantly different between the three groups (P<0.001), whereas there was no difference using conventional variables. CONCLUSION: Postoperative LV 2D strain is a feasible and reproducible method. Strain measurements seem to indicate correlation with ACC duration.
Subject(s)
Cardiac Surgical Procedures , Echocardiography/methods , Heart Defects, Congenital/diagnosis , Heart Ventricles/diagnostic imaging , Ventricular Function, Left/physiology , Child , Child, Preschool , Feasibility Studies , Female , Follow-Up Studies , Heart Defects, Congenital/physiopathology , Heart Defects, Congenital/surgery , Heart Ventricles/physiopathology , Humans , Male , Postoperative Period , Prognosis , Prospective StudiesABSTRACT
Chemotherapy-induced cardiotoxicity is a major cause of morbidity and mortality in cancer survivor. The most clinically evident and best known cardiotoxicity is the anthracycline adverse effect with heart failure. Many cardiovascular adverse effects appear after cancer therapy: heart congestive failure, myocardial ischemia, hypertension, thromboembolic complications, arrhythmias and conduction disturbances. There are potential strategies to mitigate the risks of cardiac complications for cancer patients with physical examination, echocardiography and electrocardiogram. The management of the cardiotoxicity is variable.
