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Ventricular Performance After Surgery for a Congenital Heart Defect as Assessed Using Advanced Echocardiography: From Doppler Flow to 3D Echocardiography and Speckle-Tracking Strain Imaging

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Abstract

A varying degree of impairment of ventricular performance is observed over the long-term after surgery for a congenital heart defect (CHD). Impaired ventricular performance has been shown to be of prognostic value for increased risk of cardiovascular events in adult CHD patients. This emphasizes the importance of delineating the timing and cause of this postoperative impairment. Impairment of ventricular performance could develop over time as a consequence of residua, sequelae and complications of the CHD or surgical procedure. Yet, impaired ventricular performance has also been observed immediately after surgery and can persist and/or worsen over time. This postoperative impairment of ventricular performance is the focus of this review. This article provides an overview of echocardiographic techniques currently used to assess ventricular performance. Furthermore, we review current literature describing ventricular performance, as assessed using echocardiography, after correction of a CHD. In general, a decrease in ventricular performance is observed directly after surgery for CHD’s. Subsequent follow-up of ventricular performance is characterized by a varying degree of postoperative recovery. A consistent observation is the persistent impairment of right-ventricular performance after repair in several different subgroups of CHD patients ranging from ventricular septal defect repair to surgery for Tetralogy of Fallot.

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Abbreviations

3DE:

3-Dimensional echocardiography

ASD:

Atrial septal defect

ASO:

Arterial switch operation

CHD:

Congenital heart defect

CPB:

Cardiopulmonary bypass

EF:

Ejection fraction

FAC:

Fractional area change

FS:

Fractional shortening

IVA:

Isovolumetric myocardial acceleration

LV:

Left-ventricular

MPI:

Myocardial performance index

MRI:

Magnetic resonance imaging

PR:

Pulmonary regurgitation

RV:

Right-ventricular

RVOT:

Right-ventricular outflow tract

SR:

Strain rate

TAPSE:

Tricuspid annular plane systolic excursion

TDI:

Tissue Doppler imaging

TGA:

Transposition of great arteries

ToF:

Tetralogy of Fallot

VSD:

Ventricular septal defect

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Acknowledgment

L. M. Klitsie is supported by a grant from the MD/PhD project Leiden University, Leiden, Netherlands.

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  1. Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Room J6-S, PO Box 9600, 2300 RC, Leiden, The Netherlands

    Liselotte M. Klitsie, Arno A. W. Roest, Nico A. Blom & Arend D. J. ten Harkel

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  1. Liselotte M. Klitsie
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  2. Arno A. W. Roest
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  3. Nico A. Blom
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  4. Arend D. J. ten Harkel
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Correspondence to Arend D. J. ten Harkel.

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Klitsie, L.M., Roest, A.A.W., Blom, N.A. et al. Ventricular Performance After Surgery for a Congenital Heart Defect as Assessed Using Advanced Echocardiography: From Doppler Flow to 3D Echocardiography and Speckle-Tracking Strain Imaging. Pediatr Cardiol 35, 3–15 (2014). https://doi.org/10.1007/s00246-013-0802-5

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