Abstract 14228: Ventricular Septal Dysfunction After Surgical Closure of Multiple Ventricular Septal Defects: An Analysis Using Two-Dimensional Speckle Tracking Imaging
Background: Although surgical results of multiple muscular ventricular septal defects (mVSDs) have been improved by new surgical techniques, some cases suffer from serious left ventricular dysfunction after the operation. We assessed the global and regional ventricular septal functions by 2D speckle tracking in children who underwent closure of mVSDs to determine the optimal surgical strategy for mVSDs..
Methods: Forty-eight children were studied: 17 children who underwent closure of mVSDs, 6 children who underwent closure of solitary perimembranous VSD and 25 normal control subjects. In children with mVSDs, 62 ventricular septal defects were closed by one of three different techniques (patch closure: 18 subjects, sandwich technique: 7 subjects, direct closure: 37 subjects). Speckle tracking was applied to 3 short-axis images (basal, midventricular, apical). Each image was automatically divided into 6 segments. For each segment, the peak systolic radial displacement was normalized by LVEDd and was measured. The septal displacement score (SDS) was defined as the sum of the peak systolic radial displacement of 6 septal segments.
Results: The peak systolic radial displacement parameters of the 3 segments (midventricular anteroseptum, apical anteroseptum, apical septum) were significantly lower in the subjects with mVSDs than in the control subjects. SDS was also significantly lower in children with mVSD (34.2±21.0) than control subjects (56.3±16.2). In children with mVSDs, the SDS correlated with total VSD area/body surface area ratio (r=-0.674, p<0.01). The peak systolic radial displacement decreased in the segments closed by the patch and sandwich technique (p<0.05), whereas it was preserved in the segments that were closed directly (patch: 3.6±5.9, sandwich: 3.8±2.4, direct: 5.9±4.8, other septal segments: 7.2±4.7).
Conclusions: The postoperative ventricular septal function was significantly reduced in children with mVSDs, and it was associated with the total VSD area. Surgeon should try to close mVSD directly to minimize postoperative ventricular septal dysfunction,
- © 2010 by American Heart Association, Inc.