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. 2022 May 3;5(3):e613.
doi: 10.1002/hsr2.613. eCollection 2022 May.

Biventricular strain and strain rate impairment shortly after surgical repair of tetralogy of Fallot in children: A case-control study

Bahar Dehghan  1 , Alireza Ahmadi  1 , Shima Sarfarazi Moghadam  1 , Mohammad Reza Sabri  1 , Mehdi Ghaderian  1 , Chehreh Mahdavi  1 , Mohsen Sedighi  2 , Hamid Bigdelian  1
Affiliations

Biventricular strain and strain rate impairment shortly after surgical repair of tetralogy of Fallot in children: A case-control study

Bahar Dehghan et al. Health Sci Rep. .

Abstract

Background: Early biventricular dysfunction in repaired tetralogy of Fallot (TOF) children may lead to poor clinical outcomes. We aimed to assess biventricular function in TOF children before and after surgery by speckle tracking echocardiography (STE) and compare them with the controls.

Methods: Twenty repaired TOF children and 20 normal children as controls were assessed by STE. Tricuspid annular plane systolic excursion (TAPSE), left ventricular ejection fraction (LVEF), biventricular strain, and strain rate were compared before and after surgery and between TOF children and controls.

Results: Postoperative LVEF (p = 0.001), strain (p = 0.001), and strain rate (p = 0.001) for left ventricle improved significantly compared to preoperative phase. However, postoperative left ventricular strain (p = 0.05) and strain rate (p = 0.01) in TOF children were significantly impaired compared to controls. Postoperative LVEF was correlated inversely with postoperative strain rate (r = -0.40, p = 0.04). Postoperative TAPSE (p = 0.001), strain (p = 0.001), and strain rate (p = 0.001) for right ventricle significantly worsened when compared with the preoperative phase. Moreover, postoperative TAPSE (p = 0.001), strain (p = 0.001), and strain rate (p = 0.01) were significantly impaired compared to controls. Postoperative right ventricular strain rate was correlated significantly with the weight of children (r = 0.48, p = 0.02), and postoperative left ventricular strain showed significant correlations with aortic clamp time (r = 0.44, p = 0.04) and with ICU stay (r = -0.46, p = 0.04).

Conclusion: Despite normal LVEF, TOF children exhibit impaired left ventricular strain and strain rate after surgery. TAPSE, strain, and strain rate for the right ventricle worsen after surgical repair. STE-driven strain can be used to detect early ventricular dysfunction and the associated prognostic implications.

Keywords: STE; TOF; corrective surgery; ventricular dysfunction.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Comparison of LVEF, strain, and strain rate for left ventricle in TOF children (n = 19) and controls (n = 20) measured by speckle‐tracking echocardiography (STE). LVEF, left ventricular ejection fraction; SR, strain rate; TOF, tetralogy of Fallot. ***p < 0.001 (in comparison with preoperative); # p < 0.05, ## p < 0.01 (in comparison with postoperative)
Figure 2
Figure 2
Comparison of TAPSE, strain, and strain rate values for right ventricle in TOF children (n = 19) and controls (n = 20) measured by speckle‐tracking echocardiography (STE). SR, strain rate; TAPSE, tricuspid annular plane systolic excursion; TOF, tetralogy of Fallot. ***p < 0.001 (in comparison with preoperative); ### p < 0.001 (in comparison with postoperative)
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