0410: Right ventricular systolic strain evolution during peri-operative management of congenital heart diseases

Clement Karsenty,Sébastien Hascoët,Khaled Hadeed,Romain Amadieu,Xavier Alacoque,Rose Fesseau,Yves Dulac,Sophie Breinig,Bertrand Leobon,Philippe Acar

doi:10.1016/s1878-6480(15)71758-1

Clement Karsenty, Sébastien Hascoët + Show 8 more

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https://doi.org/10.1016/s1878-6480(15)71758-1

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Abstract

RV systolic strain evolution during peri-operative management of congenital heart diseases (CHD) is unknown. In this prospective study, RV peak systolic strain (PSS) was measured using 2D speckle tracking echocardiography (Qlab10.0 software, Philips) in 39 children undergoing surgery of a CHD (Median age: 17 months, min 6 day-old, max 14.3 year-old). Three measures were performed the day before surgery, few hours after the surgery and before discharge and compared to conventional echocardiographic parameters of RV and left ventricular (LV) function. The relationships between the evolution of RV-PSS, peri-operative parameters and the type of CHD were assessed. Mean RV-PSS at baseline was - 19.5±4.8. RV-PSS was moderately correlated with the heart rate (r=0.49), the LV Tmad (r=-0.48), the TAPSE (r=-0.54) and the tricuspid S’ wave (r=-0.44)(all p<0.05). RV-PSS was decreased in cyanotic CHD (p<0.05), in children with congestive symptoms (p=0.01) and increased in ASD (p=0.02). RV-PSS was higher in RV volume increased condition such as ASD than in RV pressure increased condition such as Fallot tetralogy (p=0.006). RV-PSS decreased after surgery (p<0.0001). Mean difference between pre- and post-operative RV-PSS was 7.5±4.4. The difference was correlated with initial RV-PSS (r=-0.80), the weight (r=0.54), the ultrafiltration rate (r=0.43)(all p<0.05) but not with the duration of aortic clamp, the duration of extracorporeal circulation (n=31), the troponin peak level nor the lactates peak level. A higher difference was associated with a shorter duration of mechanical ventilation (p=0.04) and a shorter stay in intensive care unit (P=0.03). RV-PSS was better at discharge (median 6 days, p=0.0009) but remained lesser than at the initial exam (p<0.0001). RV-PSS decrease after surgery of CHD. This decrease seems mainly related to loading condition rather than to RV contractility given its relationship with a faster post-operative evolution.

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