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Left ventricular mechanics after closure of ventricular septal defect: influence of size of the defect and age at surgical repair

Published online by Cambridge University Press:  19 August 2008

Giuseppe Pacileo ,
Carlo Pisacane ,
Maria Giovanna Russo ,
Franca Zingale ,
Umberto Auricchio ,
Carlo Vosa  and
Raffaele Calabrò
Giuseppe Pacileo*
Affiliation:
Pediatric Cardiology and Pediatric Cardiac Surgery, University of NaplesMonaldi Hospital, Naples, Italy
Carlo Pisacane
Affiliation:
Pediatric Cardiology and Pediatric Cardiac Surgery, University of NaplesMonaldi Hospital, Naples, Italy
Maria Giovanna Russo
Affiliation:
Pediatric Cardiology and Pediatric Cardiac Surgery, University of NaplesMonaldi Hospital, Naples, Italy
Franca Zingale
Affiliation:
Pediatric Cardiology and Pediatric Cardiac Surgery, University of NaplesMonaldi Hospital, Naples, Italy
Umberto Auricchio
Affiliation:
Pediatric Cardiology and Pediatric Cardiac Surgery, University of NaplesMonaldi Hospital, Naples, Italy
Carlo Vosa
Affiliation:
Pediatric Cardiology and Pediatric Cardiac Surgery, University of NaplesMonaldi Hospital, Naples, Italy
Raffaele Calabrò
Affiliation:
Pediatric Cardiology and Pediatric Cardiac Surgery, University of NaplesMonaldi Hospital, Naples, Italy
*
Dr Giuseppe Pacileo, via S. Giacomo dei Capri, 125 (SECA), 1-80131 Naples, Italy. Fax: 81 7062355; E-mail: rafcalab@unina.it
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Abstract

To evaluate the influence of the size of the defect and the age of surgical repair on left ventricular mechanics, including geometry, shape, diastolic and systolic function as well as myocardial contractility, we used cross-sectional echo-Doppler to study 20 patients (12 males, 8 females) who had undergone successful surgical closure of a ventricular septal defect. The patients were divided in two groups, corrected early and late, on the basis of the degree of left-to-right shunting (ratio of pulmonary to systemic output of greater or less than 2.5/1) and the age at the surgical repair (older or younger than 2 years of age). The group undergoing early correction included 11 patients, mean age 7.1 ± 1.8 years (range 4.2–11.8 years) having surgery at mean age of 1.3±0.6 years for a large ventricular septal defect (mean ratio of pulmonary to systemic output of 3.1/1; range 3.4–2.7/1) with a mean postoperative follow-up 4.6±1.9 years. The group of nine patients undergoing late correction had a mean age of 11.3±4.9 years (range 6.7–17.2 years), with a later surgical repair (mean age 4.7±2.7 years) for a moderate-sized ventricular septal defect (mean pulmonary/systemic output ratio 2.1/1; range 2.3–1.7) and a mean postoperative follow-up of 7±4.2 years. Each group of surgically repaired patients was compared with a control group matched for age, body surface area and gender. No significant differences were found between the normal controls and those undergoing early correction for any assessed functional index regarding left ventricular geometry (normalized volumes and mass for body surface area, mass/volume and thickness/radius ratios), shape (long axis–short axis ratio), diastolic (mitral and pulmonary venous flow patterns) and systolic (fractional shortening and rate-corrected mean velocity of circumferential fibre shortening) function. In addition, the data points for each patient for the rate-corrected mean velocity of circumferential fibre shortening to end-systolic stress relationship were within the 95% confidence limits of normal, suggesting normal left ventricular contractility. On the other hand, the patients undergoing surgery at a later age showed a persistent increase of the normalized left ventricular end-diastolic volume and mass, with an higher mass/volume ratio and reduced end-systolic stress compared with normal controls. Furthermore, left ventricular shape (long axis–short axis ratio) was abnormal at end-diastole but with its normal values at end-systole. Our data suggest that, in the presence of a large ventricular septal defect, early successful surgical repair <2 years of age results in complete recovery of left ventricular mechanics in the postoperative follow-up. In ntrast, surgical closure at >2 years of age, even for a moderately sized ventricular septal defect, deleteriously affects postoperative left ventricular geometry and shape. Since prolonged volume overload may be detrimental to myocardial function, earlier surgical repair should be recommended.

Keywords

Left ventricular functionventricular septal defect repairechocardiography
Type
Original Articles
Information
Cardiology in the Young , Volume 8 , Issue 3 , July 1998 , pp. 320 - 328
Copyright
Copyright © Cambridge University Press 1998

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References

1.Meijboom, F, Szatmari, AUtens, E, Deckers, JW, Roelant, JRTCBos, E, Hess, J. Long–term follow–up after surgical closure of ventricular septal defect in infancy and childhood. J Am Coll 1994; 24. 1358–1364Google Scholar
2.Sigmann, JM, Perry, BL, Behrendt, DM, Stern, AM, Kirsh, M, Sloan, HE. Ventricular septal defect: results after repair ininfancy. Am J Cardiol 1977; 39: 66–71.CrossRefGoogle Scholar
3.Ellis, JH, Moodie, DS, Sterba, R, Gill, CC. Ventricular septal defect in the adult: natural and unnatural history. Am Heart J 1987; 115–120.CrossRefGoogle ScholarPubMed
4.McNamara, DG, Latson, LA. Long–term follow–up of patients with malformations for which definitive surgical repair has been available for 25 years or more. Am J Cardiol 1982; 50: 560–568.Google Scholar
5.Blake, RS, Chung, EE, Wesley, H, Halliday–Smith, KA. Conduction defects, ventricular arrythmias, and late deaths after surgical closure of ventricular septal defect. Br Heart J 1982; 47: 305–315.CrossRefGoogle ScholarPubMed
6.Leung, MP, Beerman, LB, Siewers, RD, Bahnson, HT, Zuberbuhler, JR. Long–term follow–up after aortic valvuloplasty and defect closure in ventricular septal defect with aortic regurgitation. Am JCardiol 1987; 60: 890–894.Google Scholar
7.Fridli, BLangford, Kidd S, Mustard, WT, Keith, JD. Ventricular septal defect with increased pulmonary vascular resistance. Am J Cardiol 1974; 33: 403–409.CrossRefGoogle Scholar
8.Yoshikawa, M, Sato, T. Left ventricular end–systolic wall stress to volume relationship before and after surgical closure of ventricular septal defect. Pediatr Cardiol 1987; 8: 93–98.CrossRefGoogle ScholarPubMed
9.Jarmakani, MM, Graham, TP, Canent, RV, Capp MP The effect of corrective surgery on left heart volume and mass in children with ventricular septal defect. Am J Cardiol 1971; 27: 254–258.CrossRefGoogle ScholarPubMed
10.Jarmakani, JM, Graham, TP, Canent, RV. Left ventricular contractile state in children with successfully corrected ventricular septal defect. Circulation 1972; 45–46 (suppl. I): 102–110.Google Scholar
11.Cordell, D, Graham, TP, Atwood, GF, Boerth, RC, Boucek, RJ, Bender HW Left heart volume characteristics following ventricular septal defect closure in infancy. Circulation. 1976; 54: 294–298.CrossRefGoogle ScholarPubMed
12.Watanabe, M. Characteristics of left ventricular volume and shape following ventricular septal defect closure in infants. Jpn Assoc Thorac Surg 1982; 30: 83–95.Google Scholar
13.Maron, BJ, Redwood, DR, Hirschfeld, JW Jr. Postoperative assessment of patients with ventricular septal defect and pulmonary hypertension. Response to intense upright exercise. Circulation 1973; 48: 864–874.CrossRefGoogle ScholarPubMed
14.Jarmakani, MM, Graham, TP, Canent, RV, Spach, MS, Capp, MREffect of site of shunt on left heart–volume characteristics in children with ventricular septal defect and patent ductus arteriosus. Circulation 1969; 50: 411–418.CrossRefGoogle Scholar
15.Ross, J Jr. Adaptations of the left ventricle to chronic volume overload. Circulation Research 1974; 34–35 (suppl. II): 64–69.Google Scholar
16.Kidd, L, Driscoll, DJ, Gersony, WM, Hayes, CJ, Keane, JF, O'Fallon, WM, Pieroni, DR, Wolfe, RR, Weidman, WHSecond natural history study of congenital heart defects. Results of treatment of patients with ventricular septal defects Circulation 1993; 87 (suppl. 1): 38–45.Google ScholarPubMed
17.Colan, SD, Borow, KM, Neumann, A. Use of the calibrated carotid pulse tracing for calculation of left ventricular pressure and wall stress throughout ejection. Am Heart J 1985; 109: 13O6–131O.CrossRefGoogle ScholarPubMed
18.Sahn, DJ, DeMaria, A, Kisslo, J, Weymann, A. The committee on M–mode standardization of American Society of Echocardiography: result of a survey of echocardiographic measurements. Circulation 1978; 58: 1072–1083.CrossRefGoogle Scholar
19.Bazett, HC. An analysis of the time relations of electrocardiograms. Heart 1920; 7. 353–370.Google Scholar
20.Silverman, NH, Ports, TA, Snider, AR. Determination of left ventricular volume in children: echocardiographic and angiographic comparisons Circulation 1980; 62: 548–557.Google Scholar
21.Schiller, NB, Skioldebrand, CG, Schiller, EJ. Canine left ventricular mass estimation by two–dimensional echocardiography. Circulation 1983; 68: 210–216Google Scholar
22.Gaasch, WH. Left ventricular radius to wall thickness ratio. Am J Cardiol 1979, 43: 1189–1194.Google Scholar
23.Borow, KM, Lang, RM, Neumann, A, Caroll, JD, Rajfer, SI. Physiologic mechanisms governing hemodynamic responses to positive inotropic therapy in patients with dilated cardiomyopathy. Circulation 1988; 77: 625–637.CrossRefGoogle ScholarPubMed
24.Grossman, W, Jones, D, McLaurin, LRWall stress and pattern of hypertrophy in the human left ventricle. MJ Clin Invest 1975, 56: 56–64.CrossRefGoogle ScholarPubMed
25.Colan, SD. Borow, KM, Neumann, A. Left ventricular end–systolic wall stress–velocity of fiber shortening relation: a load independent index of myocardial contractility. J Am CollCardiol 1984; 4: 715–724.CrossRefGoogle ScholarPubMed
26.Snider, AR, Serwer, GA. Echocardiography in Pediatric Heart Disease. Year Book, Chicago, 1990, pp. 118–119.Google Scholar
27.Bowman, LK, Lee, A, Jaffe, CC, Mattera, J, Wackers, FJThZaret, BL. Peak filling rate normalized to mitral stroke volume: a new Dopper echocardiographic filling index validated by radionuclide angiographic techniques. J Am Call Cardiol 1988 12 937–943.CrossRefGoogle Scholar
28.Masuyama, TLee, JMTamai, M, Kamada, T. Pulmonary venous flow velocity pattern as assessed with transthoracic pulsed Doppler echocardiography in subjects with out cardiac disease. Am J Cardiol 1991; 67: 1396–1404.CrossRefGoogle Scholar
29.Morris, CD, Menashe, VD. 25 year mortality after surgical repair of congenital heart defect in childhood. J Am Med Assoc 1991; 266: 3447–3452.Google Scholar
30.Otterstad, JE, Froysaker, T, Simonsen, S. Long term results after operative treatment of ventricular septal defect in adolescents 40 and adults. Acta Med Scand 1986 (suppl.); 708: l–39.Google Scholar
31.Rychik, J, Lieb, DR, Jacobs, ML, Norwood, WI, Chin, AJ. Acute changes in left ventricular geometry following removal of volume overload. Cardiol Young 1993; 4: 12 (abstract)Google Scholar
32.Hutchins, GM, Bulkley, BH, Moore, GW, Piaso, MA, Lohr, FT. Shape of the human cardiac ventricles. Am J Cardiol 1978; 41: 646–654.CrossRefGoogle ScholarPubMed
33.Gould, KL, Lipscomb, K, Hamilton, GW, Kennedy, JWRelation of left ventricular shape, function and wail stress in man. Am J Cardiol 1974; 34: 627–634.CrossRefGoogle Scholar
35.Fischl, SJ, Gorlin, R, Herman, MVCardiac shape and function in aortic valve disease: physiologic and clinical implications. Am J Cardiol 1977 39: 170–176.Google Scholar
36.Lang, RM, Borow, KM, Neumann, A, Janzen, D. Systemic vascular resistance: an unreliable index of left ventricular afterload. Circulation 1986; 74: 1114–1123.CrossRefGoogle ScholarPubMed
37.Carabello, BA, Nolan, SP, McGuire, LB. Assessment of preoperative left ventricular function in patients with mitral regurgitation: value of the end–systolic wall stress–end–systolic volume ratio. Circulation 1981; 64: 1212–1217.Google Scholar
38.Grossman, W, McLaurin, LPDiastolic properties of the left ventricle. Ann Inter Med 1976; 84: 316–325.CrossRefGoogle ScholarPubMed
39.Tavli, V, Al–Khatib, Y, Williams, RG, Tavli, T, Kaplan, S. Left ventricular Doppler inflow signals in children with isolated ventricular septal defect. Am J Cardiol 1992; 70: 1095–1096.Google Scholar
40.Appleton, CP, Hatle, LK, Poppe, RL. Relation of transmitral flow velocity pattern to left ventricular diastolic function. New insights from a combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol 1988; 12: 426–431.Google Scholar
41.Rossvoll, O, Hatle, LK. Pulmonary venous flow velocities recorded by transthoracic Doppler ultrasound: relation to left ventricular diastolic pressures. J Am Coll Cardiol 1993; 21: 1687–7696.CrossRefGoogle ScholarPubMed
42.Jablonsky, G, Hilton, D, Liu, PP, Morch, JE, Druck, MN, Bar–Shlomo, BZ, McLaughin, PR. Rest and exercise ventricular function in adults with congenital ventricular septal defects. AmJ Cardiol 1983: 51: 293–298.CrossRefGoogle ScholarPubMed