Short term evaluation of right ventricular longitudinal strain in children post balloon pulmonary valvuloplasty

Abstract

Background Children with isolated severe valvular pulmonary stenosis (sPS) are considered under chronic right ventricle (RV) pressure overload. Little is known about the needed duration for reverse remolding in pediatrics. Objective The study aimed to compare RV function and longitudinal strain in children before and 3 months after balloon pulmonary valvuloplasty (BPV). Patients and methods Thirty-seven children with sPS indicated for BPV were recruited. All patients underwent RV evaluation by Tissue Doppler (TDI) and speckle-tracking echocardiography. RV free-wall longitudinal strain (RV-FW), global RV strain (RV-4C), and global LV strain (GLS-LV) were studied one day before the procedure, 3 months postintervention, and compared with 37 healthy children enrolled as controls. Patient demographic and hemodynamic data during cardiac catheterization was collected. Results Successful BPV of 37 cases (mean age 3.2±4.9 years) showed a significant reduction in transpulmonary gradient from 89.2±23.9 mmHg to 16.1±8.4 mm Hg immediately postprocedure. The RV-FW and RV-4C of patients with sPS and GLS-LV were significantly lower than the control group (P=0.001), respectively. A significant rise of RV-FW and RV-4C occurred 3-month postintervention (−17.5±3.8 vs. 27.4±4.4) and (−15.3±3.8 vs. −23.9±3.9, P=0.001), respectively, and became insignificantly different from the control group. GLS-LV is positively correlated to RV-FW (r=0.342, P=0.038). Cases aged less than 1 year showed a significant rise of RV strains 24 h postprocedure. Conclusion Improvement of RV longitudinal strains of children is highly possible within 3 months of successful BPV up to normalization especially for infants below the age of one year.