The Possibility of Predicting Left Ventricular Dysfunction in the Early Postoperative Period in Children With Ventricular Septal Defect

Highlights The article reflects data of an original study on the diagnosis of early postoperative dysfunction in children under 1 year of age after correction of a ventricular septal defect. The relationship between troponin I and conventional echocardiographic parameters, left ventricular longitudinal strain (S, % LV), and parameters reflecting central hemodynamics was assessed. The predictive ability of S, % LV in predicting a decrease in cardiac index after surgery was revealed. Abstract Aim. To evaluate the possibility of predicting left ventricular (LV) dysfunction in the early postoperative period in children with ventricular septal defect (VSD). Methods. The study included 204 children under 1 year of age with non-restrictive perimembranous VSD. All parameters were evaluated before surgery, 6 hours, 24 hours and 10 days after surgery. 125 healthy children were enrolled as the control group. Results. 6 hours after surgery, there was a statistically significant decrease in LV ejection fraction (EF) (Me 55 [K3 60–K1 45] %, p = 0.0001), stroke index (SI) of LV outflow tract (LVOT) (12, 07 [16.38–8.24] mL/m2, p = 0.0001), and cardiac index (CI) (1.52 [2.08–1.07] L/min/m2, p = 0.0001). Arterial elasticity (AE) increased (21.4 [32.4–15.79] mm Hg/mL, p = 0.002), indicating a significant increase in afterload. Arterial compliance (AC) decreased (0.058 [0.081-0.038] mL/mm Hg, p = 0.0001), whereas ventricular-arterial coupling (VAC) value significantly increased (2 [2.54–1.67], p = 0.009). There was a dependence between LVOT SI and age (Rs = 0.45, p = 0.03), a moderate relationship between LVOT SI and VAC (Rs = –0.59, p = 0.001), a pronounced relationship between LVOT SI and AC (Rs = 0, 93, p = 0.02), pronounced relationship between LVOT SI and AE (Rs = –0.94, p = 0.03), moderate correlation between VAC and SI (Rs = –0.44, p = 0.04), weak relationship between VAC and patient age (Rs = –0.28, p = 0.03). Longitudinal deformity before surgery (b = 0.028; F = 3.9; p = 0.006) and VSD size (b = -0.08; F = 3.4; p = 0.029) were significantly associated with LV SI dynamics 6 hours after surgery. Dependence equation was as follows: 2.8 – 0.08 * VSD + 0.028 * S. A predictive ability to reduce CI 6 hours after surgery was revealed: longitudinal strain (S), % with a threshold “–” 14.3% (sensitivity 96.2%, specificity 81.6%, AUC 0.92, p<0, 00001) and VSD diameter with a threshold of 8 mm (sensitivity 75%, specificity 52%, AUC 0.69, p<0.0001). Conclusion. In the early postoperative period, there is a decrease in systolic and LV pump function. High AE rates are associated with a decrease in AC and an increase in VAC. Preoperative predictors of SI decrease are as follows: S, %> “–” 14.3 and VSD size > 8 mm.