Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Evaluation of short-term cardiac function by tissue Doppler imaging in pre and postoperative period of congenital heart disease

조직 도플러 영상을 이용한 선천성 심장병 수술 전후의 단기 심기능 평가

  • Lee, Jun-Hwa (Department of Pediatrics, School of Medicine, Sungkyunkwan University, Masan Samsung Hospital) ;
  • Kim, Yeo-Hyang (Department of Pediatrics, School of Medicine, Keimyung University) ;
  • Hyun, Myung-Chul (Department of Pediatrics, School of Medicine, Kyungpook National University) ;
  • Lee, Sang-Bum (Department of Pediatrics, School of Medicine, Kyungpook National University)
  • 이준화 (마산삼성병원 소아과) ;
  • 김여향 (계명대학교 의과대학 소아과학교실) ;
  • 현명철 (경북대학교 의과대학 소아과학교실) ;
  • 이상범 (경북대학교 의과대학 소아과학교실)
  • Received : 2007.04.05
  • Accepted : 2007.04.15
  • Published : 2007.05.15
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Abstract

Purpose : The objective of this study was to assess ventricular function by tissue Doppler imaging (TDI) in children with congenital heart disease (CHD) who have been undergoing open heart surgery (OHS) using cardiopulmonary bypass. We tried to compare the parameters of tissue Doppler imaging before and after OHS in patients with congenital heart disease. Methods : This study was conducted on 32 patients with CHD after OHS from January 2005 to December 2005 at Kyungpook National University hospital. Patients who underwent 2-D echocardiography before and after their OHS. All patients were divided into three groups, left ventricular volume overloading group (group 1), and right ventricular volume overloading group (group 2), and right ventricular pressure overloading group (group 3). The TDIs were examined before and 1 to 3 months after OHS. Peak early diastolic (E), and peak late diastolic (A) velocity of transmitral flow were measured by pulsed wave Doppler examination. Peak systolic (Sm), peak early diastolic (Em), and peak late diastolic (Am) velocity in apical 4-chamber and 2-chamber views were measured by TDI. The author calculated E/Em ratio. Results : The patients were 14 boys and 18 girls and the average age of patients was 2 years and 3 months. The congenital heart diseases which have to get OHS were ventricular septal defect (13 cases), atrial septal defect (7), atrioventricular septal defect (3), isolated pulmonary stenosis (2) and tetralogy of Fallot (7). There were significant decrease of Sm, Em, Am measured on tricuspid annulus and E/Em measured on mitral annulus in apical 4 chamber view (P<0.05). Conclusion : This study showed significant decrease of Sm, Em, Am measured on tricuspid annulus and E/Em measured on mitral annulus in apical 4 chamber view after OHS. These changes might be due to the effects of cardiopulmonary bypass in OHS and/or hemodynamic changes after correction of congenital heart disease. To clarify these changes, further study on more patients is needed.

목 적 : 선천성 심장병을 가진 소아에서 체외 심폐 순환기를 이용한 개심술을 시행한 후 좌 우심실의 기능의 변화를 조직 도플러 영상을 이용하여 측정하고, 이를 개심술 이전과 비교함으로써 수술 이후의 심실 기능 변화를 살펴 보고자 하였다. 방 법 : 2005년 1월부터 2005년 12월까지 선천성 심장병으로 경북대학교병원 소아과에 입원하여 심초음파 및 진단적 심도자술 검사를 받은 후 개심술을 시행한 환자 총 78명 중 수술 전과 수술 후 1개월에서 3개월 사이에 심초음파를 시행하고, 두 번 모두 조직 도플러 영상이 기록된 환자 32명을 대상으로 하였다. 전체 환자군은 다시 3군으로 나누었는데, 좌심실 용적 과부하를 가지는 1군, 우심실 용적 과부하를 가지는 2군, 우심실 압력 과부하를 가지는 3군으로 분류하였다. 간헐파 도플러를 이용하여 승모판과 삼첨판 유입 혈류의 E, A 최대 속도를 측정하고, 조직 도플러 영상을 이용하여 심첨 4방도와 2방도에서 심실 중격, 승모판륜 및 삼첨판륜 외벽, 좌심실 후벽과 전벽의 기저부에서 Sm, Em, Am을 측정하였으며, E/Em을 구하였다. 결 과 : 개심술 당시 대상 환자 군의 평균 나이는 27개월(1개월-156개월)이었고, 남자 14명, 여자 18명이었다. 개심술을 시행한 심장병으로는 심실 중격 결손 13명, 심방 중격 결손 7명, 방실 중격 결손 3명, 단순 폐동맥 협착 2명, 및 활로씨 4징 7명이었다. 좌심실 용적 과부하 군인 1군의 승모판륜 외벽의 E/Em, 삼첨판륜 외벽의 Sm, Em, Am, 심실 전벽의 Em, Am, 우심실 용적 과부하 군인 2군의 삼첨판륜 외벽의 Sm, Em, Am, 심실 전벽의 Sm, Em, 심실 중격과 후벽의 Em, 우심실 압력 과부하 군인 3군의 삼첨판륜 외벽의 Sm, Em, Am, 심실 전벽의 Am 값들도 수술 전과 비교하여 수술 후에 통계학적으로 의미있는 감소가 있었다. 결 론 : 선천성 심장병 환자의 수술 전과 수술 후의 조직 도플러 영상 측정값을 비교하였을 때 모든 환자 군에서 삼첨판륜 외벽의 Sm, Em, Am 값의 감소를 보이고, 좌심실 용적 과부하군에서는 좌심실 이완기압을 반영한다고 할 수 있는 승모판륜 외벽의 E/Em 값이 수술 전에 비해 수술 후에 통계학적으로 유의한 감소를 보였다. 이들은 체외 심폐 순환기를 이용한 개심술의 심장에 대한 영향 및 선천성 심장병의 교정 후의 용적, 압력의 변화 영향을 모두 반영하는 것으로 생각된다. 그러나 이러한 결과가 어느 정도까지 체외 심폐 순환기를 이용한 개심술에 의한 영향을 반영하는지에 대해서는 더 많은 연구가 필요할 것으로 생각된다.

Keywords

References

  1. Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol 2002;39:1890-900 https://doi.org/10.1016/S0735-1097(02)01886-7
  2. Choong CY, Herrmann HC, Weyman AE, Fiffer MA. Preload dependence of Doppler-derived indexes of left ventricular diastolic function in humans. J Am Coll Cardiol 1987;10:800-8 https://doi.org/10.1016/S0735-1097(87)80273-5
  3. Stoddard MF, Pearson AC, Kern MJ, Ratcliff J, Mrosek DG, Labovitz AJ. Influence of alteration in preload on the pattern of left ventricular diastolic filling as assessed by Doppler echocardiography in humans. Circulation 1989;79: 1226-36 https://doi.org/10.1161/01.CIR.79.6.1226
  4. Rychik J, Tian ZY. Quantitative assessment of myocardial tissue velocities in normal children with Doppler tissue imaging. Am J Cardiol 1996;77:1254-7 https://doi.org/10.1016/S0002-9149(96)00178-6
  5. Frommelt PC, Ballweg JA, Whitstone BN, Frommelt MA. Usefulness of Doppler tissue imaging analysis of tricuspid annular motion for determination of right ventricular function in normal infants and children. Am J Cardiol 2002;89: 610-3 https://doi.org/10.1016/S0002-9149(01)02308-6
  6. Mori K, Hayabuchi Y, Kuroda Y, Nii M, Manabe T. Left ventricular wall motion velocities in healthy children measured by pulsed wave Doppler tissue echocardiography: normal values and relation to age and heart rate. J Am Soc Echocardiogr 2000;13:1002-11 https://doi.org/10.1067/mje.2000.108131
  7. Garcia MJ, Rodrigues L, Ares M, Griffin BP, Klein AL, Stewart WJ, et al. Myocardial wall velocity assessment by pulsed Doppler tissue imaging: characteristic findings in normal subjects. Am Heart J 1996;132:648-56 https://doi.org/10.1016/S0002-8703(96)90251-3
  8. Iwasaki Y, Satomi G, Yasukochi S. Analysis of ventricular septal motion by Doppler tissue imaging in atrial septal defect and normal heart. Am J Cardiol 1999;83:206-10 https://doi.org/10.1016/S0002-9149(98)00825-X
  9. Zamorano J, Wallbridge DR, Ge J, Drozd J, Nesser J, Erbel R. Non-invasive assessment of cardiac physiology by tissue Doppler echocardiography. A comparison with invasive haemodynamics. Eur Heart J 1997;18:330-9 https://doi.org/10.1093/oxfordjournals.eurheartj.a015236
  10. Oliver M, Oleary PW, Pankratz VS, Lohse CM, Walsh BE, Tajik AJ, et al. Serial Doppler assessment of diastolic function before and after the Fontan operation. J Am Soc Echocardiogr 2003;16:1136-43 https://doi.org/10.1067/S0894-7317(03)00635-7
  11. Vitarelli A, Conde Y, Cimino E, D'Angeli I, D'Orazio S, Ventriglia F, et al. Quantitative assessment of systolic and diastolic ventricular function with tissue Doppler imaging after Fontan type of operation. Int J Cardiol 2005;102:61-9 https://doi.org/10.1016/j.ijcard.2004.04.008
  12. Eidem BW, McMahon CJ, Ayres NA, Kovalchin JP, Denfield SW, Altman CA, et al. Impact of chronic left ventricular preload and afterload on Doppler tissue imaging velocities: a study in congenital heart disease. J Am Soc Echocardiogr 2005;18:830-8 https://doi.org/10.1016/j.echo.2004.09.011
  13. Alam M, Hoglund C, Thorstrand C, Hellekant C. Haemodynamic significance of the atrioventricular plane displacement in patients with coronary disease. Eur Heart J 1992; 13:194-200 https://doi.org/10.1093/oxfordjournals.eurheartj.a060146
  14. Alam M, Hoglund C, Thorstrand C, Philip A. Atrioventricular plane displacement in severe congestive heart failure following dilated cardiomyopathy or myocardial infarction. J Internal Med 1990;228:569-75 https://doi.org/10.1111/j.1365-2796.1990.tb00281.x
  15. Tei C, Ling LH, Hodge DO, Bailey KR, Oh JK, Rodeheffer RJ, et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function-a study in normals and dilated cardiomyopathy. J Cardiol 1995;26:357-66
  16. Ishii M, Eto G, Tei C, Tsutsumi T, Hashino K, Sugahara Y, et al. Quantitation of the global right ventricular function in children with normal heart and congenital heart disease: a right ventricular myocardial performance index. Pediatr Cardiol 2000;21:416-21 https://doi.org/10.1007/s002460010100
  17. Gatzoulis MA, Norgard G, Redington AN. Biventricular long-axis function after repair of tetralogy of Fallot. Pediatr Cardiol 1998;19:128-32 https://doi.org/10.1007/s002469900260
  18. Munkhammar P, Cullen S, Jogi P, de Leval M, Elliott M, Norgard G. Early age at repair prevents restrictive right ventricular (RV) physiology after surgery for tetralogy of Fallot (TOF): diastolic RV function after TOF repair in infancy. J Am Coll Cardiol 1998;32:1083-7 https://doi.org/10.1016/S0735-1097(98)00351-9
  19. Sohn DW, Chai IH, Lee DJ, Kim HC, Oh BH, Oh BH, et al. Assessment of mitral annulus velocity by Doppler tissue imaging in evaluation of left ventricular diastolic function. J Am Coll Cardiol 1997;30:474-80 https://doi.org/10.1016/S0735-1097(97)88335-0
  20. Pinto FJ, Wranne B, St Goar FG, Siegel LC, Haddow G, Schnittger I, et al. Systemic venous flow during cardiac surgery examined by intraoperative transesophageal echocardiography. Am J Cardiol 1992;69:387-93 https://doi.org/10.1016/0002-9149(92)90239-U
  21. Wranne B, Pinto FJ, Siegel LC, Miller DC, Schnittger I. Abnormal postoperative interventricular motion: new intraoperative transesophageal echocardiographic evidence supports a novel hypothesis. Am Heart J 1993;126:161-7 https://doi.org/10.1016/S0002-8703(07)80024-X
  22. Oki T, Tabata T, Yamada H, Wakatsuki T, Shinohara H, Nishikado A, et al. Clinical application of pulsed Doppler tissue imaging for assessing abnormal left ventricular relaxation. Am J Cardiol 1997;79:921-8 https://doi.org/10.1016/S0002-9149(97)00015-5
  23. Harada K, Toyono M, Yamamoto F. Assessment of right ventricular function during exercise with quantitative Doppler tissue imaging in children late after repair of tetralogy of Fallot. J Am Soc Echocardiogr 2004;17:863-9 https://doi.org/10.1016/j.echo.2004.04.037
  24. Toyono M, Harada K, Tamura M, Yamamoto F, Takada G. Myocardial acceleration during isovolumic contraction as a new index of right ventricular contractile function and its relation to pulmonary regurgitation in patients after repair of tetralogy of Fallot. J Am Soc Echocardiogr 2004;17:332-7 https://doi.org/10.1016/j.echo.2003.12.022
  25. Lytrivi ID, Lai WW, Ko HH, Nielsen JC, Parness IA, Srivastava S. Color Doppler tissue imaging for evaluation of right ventricular systolic function in patients with congenital heart disease. J Am Soc Echocardiogr 2005;18:1099-104 https://doi.org/10.1016/j.echo.2005.03.029
  26. Malouf PJ, Madani M, Gurudevan S, WaltmanTJ, Raisinghani AB, DeMaria AN, et al. Assessment of diastolic function with Doppler tissue imaging after cardiac surgery: effect of the 'postoperative septum' in on-pump and offpump procedures. J Am Soc Echocardiogr 2006;19:464-7 https://doi.org/10.1016/j.echo.2005.12.001
  27. Giorgi D, Bello VD, Talini E, Palagi C, Donne MGD, Nardi C, et al. Myocardial function in severe aortic stenosis before and after aortic valve replacement: a doppler tissue imaging study. J Am Soc Echocardiogr 2005;18:8-14 https://doi.org/10.1016/j.echo.2004.08.012
  28. Lehman KG, Lee FA, McKenzie WB, Barash PG, Prokop EK, Durkin MA, et al. Onset of altered interventricular septal motion during cardiac surgery. Assessment by continuous intraoperative transesophageal echocardiography. Circulation 1990;82:1325-34 https://doi.org/10.1161/01.CIR.82.4.1325
  29. Righetti A, Crawford MH, O'Rourke RA, Schelbert H, Daily PO, Ross J Jr. Interventricular septal motion and left ventricular function after coronary bypass surgery: evaluation with echocardiography and radionuclide angiography. Am J Cardiol 1977;39:372-7 https://doi.org/10.1016/S0002-9149(77)80091-X