Ocena funkcji systemowej prawej komory z wykorzystaniem tkankowej echokardiografii doplerowskiej u dzieci z zespołem niedorozwoju lewego serca po operacji metodą Fontana — wyniki wstępne

Abstract

Introduction. Difficulties in the echocardiographic assessment of single ventricle function, particularly with right ventricular morphology, prompt to use different available echocardiographic techniques. Echocardiographic evaluation of the degree of hemodynamic disturbances affecting systemic ventricular function not only allows better investigation of the cardiovascular system but also helps determine prognostic factors to guide further therapeutic decisions. The role of tissue Doppler imaging (TDI) in paediatric patients with univentricular heart has been highlighted but only few studies evaluated the utility of this method in the evaluation of systemic ventricle systolic and diastolic function after the Fontan procedure. The aim of the study was to assess the relationship between conventional echocardiographic and TDI parameters in the evaluation of the performance of a functional single right ventricle in children with hypoplastic left heart syndrome (HLHS) after the Fontan procedure. Material and methods. A total of 34 patients with HLHS after staged surgical treatment culminating in the Fontan procedure underwent evaluation, including medical interview, physical examination, electrocardiography, and transthoracic echocardiography in standard views using M-mode, two-dimensional imaging, continuous and pulsed wave Doppler, colour Doppler, and TDI. The effect of demographic and perioperative factors on selected parameters of the echocardiographic evaluation of systemic ventricular function was analysed. In addition, we evaluated relations between conventional echocardiographic and TDI parameters in the evaluation of single right ventricular function in children after Fontan procedure. Results. Statistical analysis showed no significant correlation between TDI parameters of systolic and diastolic function (E’, E’/A’) and standard echocardiographic indices (E, A, E/A). Likewise, no significant correlation was found between the myocardial performance index (MPI) obtained from TDI and conventional MPI. A significant correlation was found between the E/E’ ratio and MPI. Conclusions. No significant correlation found in children after Fontan procedure between diastolic function parameters and right ventricular MPI measured using TDI and conventional echocardiographic parameters indicates that TDI is a technique complementary to conventional echocardiography in the evaluation of single right ventricle function in children. In addition, TDI does not depend on preload, and thus it can be speculated that this technique may identify ventricular dysfunction (mostly diastolic) at a stage when conventional echocardiographic parameters are still normal. Further studies in a larger number of patients are needed to support these conclusions.