Disparity in right vs left ventricular recovery during follow-up after ventricular septal defect correction in children

Klitsie, Liselotte M.; Kuipers, Irene M.; Roest, Arno A.W.; Hulst, Annelies E. van der; Stijnen, Theo; Hazekamp, Mark G.; Blom, Nico A.; Harkel, Arend D J Ten

doi:10.1093/ejcts/ezt003

Cited by 32 publications

(24 citation statements)

References 24 publications

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“…50-62,64-69 There were eight manuscripts eligible from Friedberg and Mertens et al (Toronto) 20,50-56 and six manuscripts eligible from Marcus et al (Netherlands) 16,58-62 that compared strain from a large database of overlapping pediatric controls to different disease outcomes in children, or healthy children. In consultation with the authors, the datasets from Fernandes et al 20 (Toronto) and Marcus et al 16 (Netherlands) were chosen as they contained the largest amount of control patients.…”

Section: Electronic Database Search Hedgesmentioning

confidence: 99%

Reference Ranges of Left Ventricular Strain Measures by Two-Dimensional Speckle-Tracking Echocardiography in Children: A Systematic Review and Meta-Analysis

Levy

Machefsky

Sanchez

et al. 2016

Journal of the American Society of Echocardiography

258

215

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Background The establishment of the range of reference values and associated variations of two-dimensional speckle-tracking echocardiography (2DSTE) derived left ventricular (LV) strain is a prerequisite for its routine clinical adoption in pediatrics. The aims were to perform a meta-analysis of normal ranges of LV global longitudinal, circumferential, and radial strain (GLS, GCS, and GRS) measurements derived by 2DSTE in children and identify confounding factors that may contribute to variances in reported measures. Methods A systematic review was launched in Medline, Embase, Scopus, CINAHL, and Cochrane. Search hedges were created to cover the concepts of pediatrics, speckle-tracking echocardiography, and left heart ventricle. Two investigators independently identified and included studies if they reported the 2DSTE derived LV GLS, GCS or GRS. The weighted mean was estimated by using random-effects with 95% confidence interval (CI), heterogeneity was assessed by the Cochran's Q statistic and the inconsistency index (I2) and publication was evaluated using the Egger test. Effects of demographic (age), clinical, and vendor variables were assessed in a meta-regression. Results The search identified 2325 children from 43 data sets. The reported normal mean values of GLS among the studies varied from -16.7% to -23.6% (mean -20.2%, 95% CI -19.5% to -20.8%), GCS varied from -12.9% to -31.4% (mean -22.3%, 95% CI -19.9% to -24.6%) and GRS, varied from 33.9% to 54.5 % (mean 45.2 95% CI 38.3 to 51.7). 26 studies reported LS only from the apical 4-chamber view with a mean of -20.4%, (95% CI -19.8% to -21.7%). 23 studies reported CS (mean, -20.3%, 95% CI -19.4% to -21.2%) and RS (mean, 46.7%, 95% CI 42.3% to 51.1%) from the short axis view at the mid-ventricular level. A significant apex-to-base segmental longitudinal strain (SLS) gradient (P < .01) was observed in the LV free wall. There was significant between- study heterogeneity and inconsistency (I2 > 94% and P < .001 for each strain measure), which was not explained by age, gender, body surface area, blood pressure, heart rate, frame rate, FR/HR ratio tissue-tracking methodology, location of reported strain value along the strain curve, ultrasound equipment, or software. These metaregression showed that these effects were not significant determinants of variations among normal ranges of strain values. There was no evidence of publication bias (P = .40). Conclusions This study defined reference values of 2DSTE derived LV strain in children on the basis of a meta-analysis. In healthy children, the mean LV global longitudinal strain value is -20.2%, (95% CI -19.5% to -20.8%), mean global circumferential strain -22.3%, (95% CI -19.9% to -24.6%), and mean global radial strain is 45.2%, (95% CI 38.3% to 51.7%). LV segmental longitudinal strain has a stable apex-to-base gradient that is preserved throughout maturations. Although variations among different reference ranges in this meta-analysis were not dependent on differences in demographic, clinical, or vendor para...

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Section: Electronic Database Search Hedgesmentioning

confidence: 99%

Reference Ranges of Left Ventricular Strain Measures by Two-Dimensional Speckle-Tracking Echocardiography in Children: A Systematic Review and Meta-Analysis

Levy

Machefsky

Sanchez

et al. 2016

Journal of the American Society of Echocardiography

258

215

View full text Add to dashboard Cite

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“…The mechanisms of impaired ventricular function and mechanics in patients after repair of different types of VSDs are not entirely clear. Klitsie et al have shown that the right ventricle is more vulnerable than the left to the effects of cardiopulmonary bypass after repair of various types of VSDs . Hypothesized mechanisms include greater susceptibility of the thin‐walled right ventricle to inflammatory cascades of cardiopulmonary bypass, greater risk of external warming of the anteriorly located right ventricle during bypass, influence of pericardiotomy and pericardial adhesions and pressure overload .…”

Section: Discussionmentioning

confidence: 99%

“…Klitsie et al have shown that the right ventricle is more vulnerable than the left to the effects of cardiopulmonary bypass after repair of various types of VSDs. 27 Hypothesized mechanisms include greater susceptibility of the thin-walled right ventricle to inflammatory cascades of cardiopulmonary bypass, 28,29 greater risk of external warming of the anteriorly located right ventricle during bypass, 30 influence of pericardiotomy and pericardial adhesions and pressure overload. 31 Our findings of significant associations between RV and LV deformation parameters further suggest that ventricular interdependence may explain in part the LV involvements.…”

Section: Discussionmentioning

confidence: 99%

Ventricular mechanics after repair of subarterial and perimembranous VSDs

Kwok

Yeung

et al. 2017

Eur J Clin Investigation

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“…Long-term follow-up studies to assess cardiac function after correction of congenital heart defects are as yet lacking. However, a recent study by Klitsie et al 3 4 that preoperative values were similar to normal (6.2 AE 1.3 cm/sec). It might be that anesthesia has already a negative influence on LV function preoperatively, since the patients of Pauliks et al were studied in the operating room, in contrast to the 1 day preoperative investigation by Klitsie et al [2][3][4] These differential findings further underscore the use of normal controls in interpreting results.…”

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confidence: 87%

Right Ventricular Wall‐Motion Changes after Infant Open Heart Surgery—A Tissue Doppler Study

et al. 2014

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Disparity in right vs left ventricular recovery during follow-up after ventricular septal defect correction in children

Cited by 32 publications

References 24 publications

Reference Ranges of Left Ventricular Strain Measures by Two-Dimensional Speckle-Tracking Echocardiography in Children: A Systematic Review and Meta-Analysis

Reference Ranges of Left Ventricular Strain Measures by Two-Dimensional Speckle-Tracking Echocardiography in Children: A Systematic Review and Meta-Analysis

Ventricular mechanics after repair of subarterial and perimembranous VSDs

Right Ventricular Wall‐Motion Changes after Infant Open Heart Surgery—A Tissue Doppler Study

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