Left ventricular rotation and torsion in neonates and infants younger than three months with symptomatic ventricular septal defect: Acute effects from open heart surgery

J Clin Ultrasound. 2019 Feb;47(2):88-94. doi: 10.1002/jcu.22650. Epub 2018 Oct 30.

Abstract

Purpose: We evaluated ventricular rotation, torsion, and strain changes in infants using preoperative and postoperative M-mode echocardiography after early surgery for symptomatic ventricular septal defects (VSD).

Methods: Thirty-five patients with VSD underwent vector velocity imaging echocardiography before and after open heart surgery. Their rotational variables were compared with 18 controls.

Results: All the patients (19 boys and 16 girls; median age: 44.4 days; range: 13-84 days) showed normal septal motion preoperatively; however, septal motion changed into flat septum or paradoxical septal motion after surgery. Left ventricular end-diastolic internal dimension and fractional shortening significantly decreased after surgery (P = .001 and P = .000). Patients showed significant postoperative reduction of peak systolic apical rotation and maximal torsion (P = .010 and P = .000). Peak systolic basal rotation decreased after surgery but it was not significantly (P = .106). No significant differences were found in longitudinal and circumferential systolic strains between patients and controls.

Conclusion: Abnormal motion of the ventricular septum was confirmed by postoperative M-mode echocardiography. Decreased rotation/torsion variables may reflect postoperative changes of ventricular loading conditions. Because systolic strain was preserved, postoperative echocardiographic results should not be interpreted as abnormal or decreased ventricular function.

Keywords: echocardiography; function; heart septal defects; surgery; ventricular.

MeSH terms

  • Cardiac Surgical Procedures / methods
  • Echocardiography / methods*
  • Female
  • Heart Septal Defects, Ventricular / diagnostic imaging*
  • Heart Septal Defects, Ventricular / physiopathology
  • Heart Septal Defects, Ventricular / surgery*
  • Heart Ventricles / diagnostic imaging
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Prospective Studies
  • Rotation
  • Ventricular Septum / diagnostic imaging