Key result
Coronary reimplantation in pediatric patients was associated with a significant decrease in left ventricular global longitudinal strain (-19.9%) compared to patients with septal defects (-20.9%) and healthy controls (-22.9%).
Why the study?
Despite normal standard echocardiographic systolic indices after arterial switch operation and coronary reimplantation, reduced exercise capacity and ischemia occur, prompting evaluation of long-term myocardial function using Doppler and speckle-tracking imaging.
Does coronary reimplantation during congenital heart surgery impair long-term myocardial performance compared to septal defect surgery and healthy controls in pediatric patients?
Case-Control (n=56)
No
Does coronary reimplantation during congenital heart surgery impair long-term myocardial performance compared to septal defect surgery and healthy controls in pediatric patients?
2D speckle-tracking echocardiography reveals subclinical impairment in left ventricular longitudinal and circumferential strain long-term after coronary reimplantation in pediatric patients, despite normal conventional echocardiographic parameters.
Answers are grounded in this paper and cite their sources.
Strain reduction after pediatric coronary reimplantation suggests possible subclinical LV impairment; leaves open need for prospective outcome studies.
INTRODUCTION: reduced exercise capacity, coronary artery abnormalities and reversible myocardial ischemia have been demonstrated after arterial switch operation (ASO) and coronary reimplantation. Despite this, indices of systolic function, assessed by standard and Doppler echocardiography, are within the normal range. The aim of this study was to highlight the long-term changes in myocardial function following coronary reimplantation using Doppler and speckle-tracking imaging (STI) echocardiography. METHODS: this observational case control study included 36 patients and 20 gender and age-matched healthy controls. A group study was performed using patients who were followed for at least 6 months after the operation and who visited the pediatric cardiology outpatient between October 2015 and May 2016. Systolic and diastolic parameters, left ventricle (LV) and right ventricle (RV) myocardial performance were assessed in each group. RESULTS: the LV global peak strain parameters revealed a significant decrease in the longitudinal and circumferential strain components. The LV global longitudinal strain (GLS) values were lower in both groups of operated patients than controls (-19.9 ± 2.2% (group 1) versus -20.9 ± 1.6% (group 2) versus -22.9 ± 2.3% (group 3), p<0.001). The patients with coronary reimplantation had the lowest values. The LV global circumferential strain was also decreased in the group 1 patients as compared with the 2 other groups (-16.6 ± 4.1% (group 1) versus -19.4 ± 3.9% (group 2) versus -19.8 ± 4.0% (group 3), p<0.001). CONCLUSION: although global LV function, assessed with conventional echocardiographic parameters, was normal, the 2D-STI analysis showed slight but significant decrease in the global and segmental longitudinal and circumferential LV strain during the long-term follow-up after coronary arteries reimplantation.
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Charfeddine et al. (2021) conducted a case-control in Congenital heart disease requiring coronary reimplantation (n=56). Coronary reimplantation vs. Surgical correction of cardiac septal defect and healthy controls was evaluated on Left ventricular global longitudinal strain (GLS) (p=<0.001). Coronary reimplantation in pediatric patients was associated with a significant decrease in left ventricular global longitudinal strain (-19.9%) compared to patients with septal defects (-20.9%) and healthy controls (-22.9%).
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