Ventricular septal dysfunction after surgical closure of multiple ventricular septal defects

Abstract

Background: We assessed the global and regional ventricular septal functions using conventional echocardiography and two-dimensional speckle tracking imaging in children with postoperative multiple ventricular septal defects.

Methods: Thirty-six children were studied: 16 with postoperative multiple ventricular septal defects and 20 normal control subjects. In children with multiple ventricular septal defects, 60 ventricular septal defects were closed using one of three different techniques (patch closure, the sandwich technique, direct closure). Speckle tracking imaging was applied to three short-axis echocardiographic images.

Results: The total patch area used in the multiple ventricular septal defects group was correlated with the postoperative ejection fraction (r=0.703) and Tei index (r=0.778). The global septal peak systolic radial displacement and global septal peak systolic radial strain in the multiple ventricular septal defects group were significantly lower than those observed in the control subjects. The peak systolic radial strain in the segments closed with patches and the peak systolic radial displacement in the segments closed with the felt sandwich technique were significantly lower than those observed in the intact septal segments. No significant regional functional depressions were identified in the segments that were closed directly.

Conclusions: The postoperative ventricular global and septal functions were significantly reduced in children with multiple ventricular septal defects, especially in the cases with complex congenital heart disease and that were closed with large prosthetic materials. These results suggest that an effort to minimize the use of patch materials may lead to preserved postoperative ventricular function.

Keywords: %PSRD; 20; 2DSTI; BSA; E/A; LV; LVDd; LVEF; PSCS; PSRD; PSRS; RBBB; TAR; VSD; body surface area; left ventricular; left ventricular ejection fraction; left ventricular end-diastolic diameter; mVSDs; multiple ventricular septal defects; peak systolic circumferential strain; peak systolic radial displacement; peak systolic radial strain; percent peak systolic radial displacement; ratio between the early and late diastolic transmitral flow velocity; right bundle branch block; transatrial reendocardialization; two-dimensional speckle tracking imaging; ventricular septal defect.