Left Ventricular Function In Infants Research Articles

The utility of speckle-tracking echocardiography in early and midterm follow-up after anomalous origin of the left coronary artery from the pulmonary artery repair.

Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a reversible cause of left ventricular (LV) dysfunction in infants. The LV function is expected to improve serially and return to normal by 1 year after surgical repair. The pattern of improvement in LV function has not been serially analyzed after ALCAPA repair. We report our preliminary experience with serial assessment of LV function in infants undergoing ALCAPA repair utilizing speckle tracking echocardiography.

Echocardiographic evaluation of left ventricle mechanical parameters in infants of the first year of life

Aim. The study focused on the analysis of the measurement range of left ventricle mechanics (strain, strain rate, rotation, rotation rate, twisting, untwisting, torsion) in healthy infants of the first year of life to obtain their baseline values.Methods. The study included 125 healthy infants aged 5 days to 12 months (average 5.9±3.9 months. The Аcuson S 2000 machine (Siemens Medical Systems, Mountain View, CA, USA) was used to perform echocardiography. The indicators of left ventricle longitudinal strain (%) and strain rate (s–1), radial strain and strain rate (% and s–1), circumferential strain and strain rate (% and s–1), basal and apical rotation in systole and diastole (°) and rotation rate (°/s), twisting (°), untwisting (°), twisting and unwinding rate (°/s) and torsion (°/cm) were measured and analyzed. Results. It was found out that the values of the longitudinal strain and strain rate inversely correlate with the pumping function (stroke volume index) and diastolic function (filling pressures and the untwisting rate). The parameters of the circular and radial strain tended to depend on the left ventricle mass index, interventricular septum/left ventricle posterior wall thicknesses. Left ventricle twisting and untwisting would increase in healthy infants from the newborn period to the first year of life. Left ventricle torsion range was determined by the twist values and not by left ventricular geometry.Conclusion. The obtained data on the values of longitudinal, circumferential and radial left ventricle strain and strain rate can be used as reference ranges to evaluate the mechanical left ventricular function in infants of the first year of life. Received 27 January 2017. Accepted 15 June 2017. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Author contributionsConception and study design: Yu.S. Sinelnikov, E.N. OrekhovaData collection and analysis: M.A. Polevshikova, T.V. Matanovskaya Drafting the article: E.N. Orekhova, M.A. PolevshikovaCritical revision of the article: Yu.S. Sinelnikov, E.N. OrekhovaFinal approval of the version to be published: Yu.S. Sinelnikov, E.N. Orekhova, T.V. Matanovskaya, M.A. Polevshikova

The effect of milrinone on right and left ventricular function when used as a rescue therapy for term infants with pulmonary hypertension.

Milrinone may be an appropriate adjuvant therapy for infants with persistent pulmonary hypertension of the newborn. We aimed to describe the effect of milrinone administration on right and left ventricular function in infants with persistent pulmonary hypertension not responding to inhaled nitric oxide after 4 hours of administration. This is a retrospective review of infants born after or at 34 weeks of gestation with persistent pulmonary hypertension who received milrinone treatment. The primary endpoint was the effect of milrinone on myocardial performance and haemodynamics, including right and left ventricular outputs, tissue Doppler velocities, right ventricle and septal strain, and strain rate. Secondary endpoints examined included duration of inhaled nitric oxide and oxygen support. A total of 17 infants with a mean (standard deviation) gestation and birth weight of 39.8 (2.0) weeks and 3.45 (0.39) kilograms, respectively, were included in the study. The first echocardiogram was performed 15 hours after the commencement of nitric oxide inhalation. Milrinone treatment was started at a median time of 1 hour after the echocardiogram and was associated with an increase in left ventricular output (p=0.04), right ventricular output (p=0.004), right ventricle strain (p=0.01) and strain rate (p=0.002), and left ventricle s` (p<0.001) and a` (p=0.02) waves. There was a reduction in nitric oxide dose and oxygen requirement over the subsequent 72 hours (all p<0.05). The use of milrinone as an adjunct to nitric oxide is worth further exploration, with preliminary evidence suggesting an improvement in both oxygenation and myocardial performance in this group of infants.

Clinical validaty of the ultrasonic cardiac output monitor used in infants after surgical repair of ventricular septal defect

Objective To investigate the accuracy and clinical utility of ultrasonic cardiac output monitor(USCOM) to measure cardiac output(CO) of infants after receiving repair of ventricular septal defect(VSD). Methods A prospective and observational study was conducted at Departments of NICU and PICU in Guangdong General Hospital with infant samples after receiving surgical repair of VSD from Oct. 2011 to Jul. 2013. Paired measures of cardiac output were obtained by using USCOM and ECHO. Paired t-test and Bland-Altman analysis were performed. Results Fifty-five subjects(38 male and 17 female, aged 1-6 months and weighing 2.42-6.50 kg) were enrolled for the final analysis. And 90-time findings from comparing cardiac output measures were obtained. The left ventricular output(LVO) measured by USCOM and ECHO was (282.0±74.2) mL/(kg·min) and (287.0±61.1) mL/(kg·min), respectively; while the right ventricular output(RVO) was (371.0±133.0) mL/(kg·min) and (377.0±107.0) mL/(kg·min), respectively. Comparison by 2 techniques for LVO showed a bias±limits of agreement of (-5.6±85.8) mL/(kg·min), a percentage error of 29.86%; for RVO, the bias±limits of agreement was (-6.0±271.4) mL/(kg·min), and the percentage error was 77.24%. Conclusions The consistency of USCOM and ECHO in LVO measurement is acceptable, while poor in RVO measurement. Due to its safe, feasible and noninvasive nature, the USCOM may play an important role in hemodynamic monitoring of the left ventricular function in infants after surgical repair of VSD. Whereas, USCOM may not be recommended for the assessment of right ventricular function. Key words: Cardiac output; Ultrasonic cardiac output monitor; Doppler echocardiography; Ventricular septal defect repair; Infant

Left ventricular function in infants and children with symptomatic Ebstein's anomaly

small size could not be explained by small parents, pulmonary vascular obstructive disease, profound failure to thrive in infancy, and intrauterine growth retardation may have caused their small size. The relation of intrauterine growth retardation and profound growth failure in infancy, and poor ultimate growth was observed by Levy and co-workers.8 The association between pulmonary vascular obstructive disease and small adult size was not reported previously. Patients in the operated group had a more marked growth response than did those in the nonoperated group, and all patients’ mean height and weight were similar as adults. “Catch-up” growth in operated patients during short and intermediate follow-up periods has been reported.ld The present study is the first to report patients followed to ultimate adult size. Time of operation, and presence of congestive heart failure in infancy did not independently influence adult size. Because these patients were observed in the 1960s and underwent operation “late,” it was gratifying to learn that most responded well to late operations. It remains to be learned whether operations in the lirst 2 years, which is a common practice currently, will have any independent effect on later size.

Echocardiographic Evaluation of Systolic Left-ventricular Function in Infants with Critical Aortic Stenosis Before and After Aortic Valvotomy

Infants with critical aortic stenosis may have global or regional left ventricular contraction abnormalities. In order to evaluate the clinical significance of these contraction abnormalities, we examined the systolic left ventricular function before and after aortic valvotomy in 16 infants operated on between 1980 and 1987. Left ventricular free wall and septal motion were studied by cross sectional echocardiography using the apical 4-chamber view. Enddiastolic and endsystolic left ventricular frames were digitized. The relative systolic reduction of the total left ventricular area (reflecting ejection fraction) as well as of 5 left ventricular sectors (reflecting regional wall motion) was calculated and compared to previously established normal values. Before valvotomy, 8 infants had normal and the other 8 impaired left ventricular systolic wall motion. These latter infants showed hypokinesia of the apex and/or the posterolateral left ventricular wall resulting in a decreased systolic reduction of the total left ventricular area. Four of these infants had evidence of myocardial infarction on intraoperative inspection. Early after operation, the systolic reduction of the total left ventricular area was normal in all infants, and the left ventricular apex and poster-lateral wall were either normo- or hyperkinetic. Follow-up studies of all infants more than 10 months and of 7 infants more than 3 years after operation showed that the left ventricular systolic wall motion remained normal in all, irrespective of whether it was normal or abnormal preoperatively. This study suggests that left ventricular contraction abnormalities in infants with critical aortic stenosis may be reversible and thus do not constitute a contraindication against aortic valvotomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of isolated right ventricular outflow obstruction on left ventricular function in infants

Resting left ventricular (LV) function was evaluated in 29 infants with isolated right ventricular (RV) outflow obstruction. Age-corrected cardiac index was significantly inversely correlated with the degree of obstruction (r = 0.59, p = 0.0001). Right ventricular hypertension resulted in septal displacement and altered LV geometry. The magnitude of RV outflow obstruction related closely to the degree of LV distortion. Septal displacement toward the LV free wall was associated with lower values for cardiac index, indexed LV end-diastolic volume, ejection fraction, ratio of early to atrial LV diastolic inflow and with a higher RV ejection fraction. The LV end-diastolic volume index and the ratio of early to atrial LV diastolic inflow correlated with the degree of obstruction and amount of septal displacement. Four infants evaluated during the development of supravalvar pulmonary stenosis demonstrated decreasing cardiac index during development of obstruction and significant increase in cardiac index after surgical relief. These findings indicate that significant RV outflow obstruction in infants is associated with a reversible alteration in LV function related to abnormal LV geometry and impaired LV diastolic filling.

First-pass measurement of left ventricular function in infants and children.

The left ventricular ejection fraction was measured in 57 infants and children with congenital heart disease by both first-pass radionuclide angiography and left ventricular cineangiography. The correlation coefficient for the two sets of measurements was 0.79. In subgroups without left to right shunts (n = 21) and with left to right shunts (n = 36) it was 0.93 and 0.37, respectively. It is concluded that measurement of the left ventricular ejection fraction by the first-pass method is valid in children, provided there is no left-to-right shunt.

Right and left heart size and function in infants with symptomatic coarctation.

Right and left heart volumes, ejection fractions and ventricular outputs were determined from biplane cineangiocardiograms in infants with symptomatic coarctation of the aorta and correlated with clinical and hemodynamic alterations. Patients were divided into two age groups: group 1, aged 3.5 to 14 days and group 2, 5 weeks to 7 1/2 months. Infants in group 1 had severe depressions of left ventricular ejection fraction and output associated with normal left ventricular size. The massive cardiomegaly in these infants results from right heart enlargement secondary to left-to-right atrial shunting, and pulmonary hypertensive right heart failure, and possibly a more distensible right than left ventricle. Infants in group 2 also have right, and to a lesser degree, left heart enlargement. Group 2 patients differ from group 1 infants in having less impairment of left heart pump function and significant left ventricular myocardial hypertrophy. Echocardiographic measurements of left ventricular pump function are normal or increased in postoperative patients. Thus alterations of left ventricular function in infants with symptomatic coarctation appear to be largely afterload related and do not indicate permanent impairment of left ventricular contractile function.