Assessment of Left Atrial Deformation in Patients with Total Anomalous Pulmonary Venous Connection by Two-dimensional Speckle-tracking Echocardiography

Overview

Journal Heart Vessels

Specialty Cardiology & Vascular Diseases

Date 2023 Feb 1

PMID 36723765

Authors

Ryusuke Numata

Kiyohiro Takigiku

Haruka Obinata

Yohei Akazawa

Kohta Takei

Affiliations

Soon will be listed here.

Abstract

Background: Total anomalous pulmonary venous connection (TAPVC) is a rare congenital heart disease of newborns characterized by impaired left ventricle growth and diastolic dysfunction. We hypothesized that the patients with TAPVC reduced blood flow into the left heart prenatally could affect left atrium (LA) not just growth but function. We compared the age-related changes in LA deformation using two-dimensional speckle-tracking echocardiography (2DSTE) in Patients with TAPVC.

Method: This single-center, retrospective cohort study was conducted on consecutive isolated TAPVC patients who underwent neonatal surgery between January 1, 2009 and January 1, 2022. The LA datasets in TAPVC patients were analyzed before surgery (n = 28) and follow-ups at 1-2 (n = 24) and 5-7 years of age (n = 13) and compared with those of age-matched healthy controls (January 2009-2022). The LA strain (ε), indicating LA function, was analyzed using QLAB represented by reservoir (εR), conduit (εCD), and contractile (εCT) strains. LA pressure was evaluated by periodic follow-up catheterization after repair.

Results: Compared to the controls, the TAPVC patients had significantly smaller LA maximum volume preoperatively, and with age, the LA maximal volumes reached normal levels, while the LA minimal volumes were larger. All 2DSTE-determined LA strains showed significant reductions at all time points in the TAPVC group compared to those in the control (median εR, εCD, and εCT; before surgery: 17.0% vs. 26.0%, 12.9% vs. 15.9%, and 6.3% vs. 10.4%; follow-up at 1-2 years: 30.0% vs. 45.7%, 23.2% vs. 29.6%, and 6.1% vs. 16.3%; follow-up at 5-7 years: 31.2% vs. 43.1%, 25.0% vs. 31.2%, and 5.2% vs. 10.8%, respectively; p < 0.05). Only εCT did not represented a significant change over time even though after correction of blood flow (median εCT: 6.0% → 5.9%). Patients with pulmonary venous obstruction (PVO) at birth showed significantly decreased εR and εCD and higher LA pressure compared to those without PVO.

Conclusion: This study showed that nevertheless maximum volume of LA was recovered within the normal range, reduced LA strains, especially contractile function lasted from birth even after repair in Patients with TAPVC.

Citing Articles

Quantification of 3-Dimensional Confluence-Atrial Morphology in Supracardiac Total Anomalous Pulmonary Venous Connection.

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PMID: 39156514 PMC: 11328765. DOI: 10.1016/j.jacasi.2024.05.002.

Postoperative evaluation of left atrial stiffness in patients with congenital heart diseases.

Oka H, Nakau K, Shibagaki Y, Ito K, Sasaki Y, Imanishi R Heart Vessels. 2023; 39(2):117-122.

PMID: 37740077 DOI: 10.1007/s00380-023-02313-1.

References

Karamlou T, Gurofsky R, Al Sukhni E, Coles J, Williams W, Caldarone C . Factors associated with mortality and reoperation in 377 children with total anomalous pulmonary venous connection. Circulation. 2007; 115(12):1591-8. DOI: 10.1161/CIRCULATIONAHA.106.635441. View

Talwar S, Arora Y, Gupta S, Kothari S, Ramakrishnan S, Saxena A . Total Anomalous Pulmonary Venous Connection Beyond the First Decade of Life. World J Pediatr Congenit Heart Surg. 2019; 10(2):185-191. DOI: 10.1177/2150135118822792. View

McBride M, Kirshbom P, Gaynor J, Ittenbach R, Wernovsky G, Clancy R . Late cardiopulmonary and musculoskeletal exercise performance after repair for total anomalous pulmonary venous connection during infancy. J Thorac Cardiovasc Surg. 2007; 133(6):1533-9. DOI: 10.1016/j.jtcvs.2006.12.032. View

Paridon S, SULLIVAN N, Schneider J, Pinsky W . Cardiopulmonary performance at rest and exercise after repair of total anomalous pulmonary venous connection. Am J Cardiol. 1993; 72(18):1444-7. DOI: 10.1016/0002-9149(93)90194-h. View

ROSENQUIST G, Kelly J, Chandra R, Ruckman R, Galioto Jr F, Midgley F . Small left atrium and change in contour of the ventricular septum in total anomalous pulmonary venous connection: a morphometric analysis of 22 infant hearts. Am J Cardiol. 1985; 55(6):777-82. DOI: 10.1016/0002-9149(85)90155-9. View

Mathew R, THILENIUS O, Replogle R, ARCILLA R . Cardiac function in total anomalous pulmonary venous return before and after surgery. Circulation. 1977; 55(2):361-70. DOI: 10.1161/01.cir.55.2.361. View

Balgradean M, Cinteza E, Cirstoveanu C, Enculescu A, Plesca D . Abnormalities in embryological development in total anomalous pulmonary venous connection. A case report. Rom J Morphol Embryol. 2013; 54(3):635-7. View

Gobergs R, Salputra E, Lubaua I . Hypoplastic left heart syndrome: a review. Acta Med Litu. 2017; 23(2):86-98. PMC: 5088741. DOI: 10.6001/actamedica.v23i2.3325. View

Marcondes L, Galati J, Jones B, Konstantinov I, dUdekem Y, Brizard C . Abnormal left ventricular diastolic function at late follow-up after repair of total anomalous pulmonary venous drainage: the impact of altered ventricular loading in utero. J Thorac Cardiovasc Surg. 2013; 148(1):238-44. DOI: 10.1016/j.jtcvs.2013.08.045. View

10.

Nakamura Y, Hoashi T, Nakata T, Shimada M, Ozawa H, Kurosaki K . Left Ventricular Function After Repair of Totally Anomalous Pulmonary Venous Connection. Ann Thorac Surg. 2018; 107(1):151-156. DOI: 10.1016/j.athoracsur.2018.07.055. View

11.

Sun B, Park J . Echocardiographic Measurement of Left Atrial Strain　- A Key Requirement in Clinical Practice. Circ J. 2021; 86(1):6-13. DOI: 10.1253/circj.CJ-21-0373. View

12.

Kutty S, Padiyath A, Li L, Peng Q, Rangamani S, Schuster A . Functional maturation of left and right atrial systolic and diastolic performance in infants, children, and adolescents. J Am Soc Echocardiogr. 2013; 26(4):398-409.e2. DOI: 10.1016/j.echo.2012.12.016. View

13.

Ghelani S, Brown D, Kuebler J, Perrin D, Shakti D, Williams D . Left Atrial Volumes and Strain in Healthy Children Measured by Three-Dimensional Echocardiography: Normal Values and Maturational Changes. J Am Soc Echocardiogr. 2017; 31(2):187-193.e1. DOI: 10.1016/j.echo.2017.10.011. View

14.

Cantinotti M, Scalese M, Giordano R, Franchi E, Assanta N, Molinaro S . Left and Right Atrial Strain in Healthy Caucasian Children by Two-Dimensional Speckle-Tracking Echocardiography. J Am Soc Echocardiogr. 2018; 32(1):165-168.e3. DOI: 10.1016/j.echo.2018.10.002. View

15.

White B, Ho D, Faerber J, Katcoff H, Glatz A, Mascio C . Repair of Total Anomalous Pulmonary Venous Connection: Risk Factors for Postoperative Obstruction. Ann Thorac Surg. 2019; 108(1):122-129. PMC: 6591098. DOI: 10.1016/j.athoracsur.2019.02.017. View

16.

Haycock G, Schwartz G, Wisotsky D . Geometric method for measuring body surface area: a height-weight formula validated in infants, children, and adults. J Pediatr. 1978; 93(1):62-6. DOI: 10.1016/s0022-3476(78)80601-5. View

17.

Lopez L, Colan S, Frommelt P, Ensing G, Kendall K, Younoszai A . Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr. 2010; 23(5):465-95. DOI: 10.1016/j.echo.2010.03.019. View

18.

Lang R, Badano L, Mor-Avi V, Afilalo J, Armstrong A, Ernande L . Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28(1):1-39.e14. DOI: 10.1016/j.echo.2014.10.003. View

19.

Kanda Y . Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant. 2012; 48(3):452-8. PMC: 3590441. DOI: 10.1038/bmt.2012.244. View

20.

Mondillo S, Cameli M, Caputo M, Lisi M, Palmerini E, Padeletti M . Early detection of left atrial strain abnormalities by speckle-tracking in hypertensive and diabetic patients with normal left atrial size. J Am Soc Echocardiogr. 2011; 24(8):898-908. DOI: 10.1016/j.echo.2011.04.014. View