Postoperative evaluation of ventricular function by tissue Doppler and speckle tracking echocardiography after surgery for congenital heart disease

Most patients with congenital heart disease nowadays survive operative
correction However, long-term
consequences of the congenital heart defect and its correction are the
persistence of residual defects, the
occurrence of rhythm disorders and the presence of heart failure. These effects
will influence daily functioning, and
many studies show differences in quality of life and decreased exercise
tolerance in these patient groups. Although
most significant changes develop during long-term follow-up, it is unclear if
intrinsic properties of the cardiac
muscle, or the effect of the first surgical correction already predict
long-term deterioration. Although the use of
cardiopulmonary bypass can lead to deterioration of ventricular performance,
its contribution to longer-term
ventricular performance is as yet unknown. One of the most prominent features
already present immediately after
surgical correction is the presence of right bundle branch block on the
electrocardiogram in many patients. This
may indicate the presence of ventricular dyssynchrony already at an early stage.
In this study we will evaluate ventricular function after surgical correction
for congenital heart disease. By using
new echotechniques as tissue Doppler imaging and speckle tracking it will be
possible to find subtle changes in
both diastolic and systolic ventricular function perioperatively. We will
therefore perform detailed echocardiography
preoperatively, 1 and 3 days, 1 week and 3 months postoperatively. We expect
that changes in ventricular function
will be largest immediately postoperatively, and will partially resolve during
recovery. It is expected that some
changes will persist during the follow-up period. In the past we performed
several studies in patients during
long-term follow-up. From these studies it became already clear that most
patients after correction for congenital
heart disease show differences in echocardiographic parameters, and changes in
exercise tolerance. It is,
however, unclear if these changes develop during growth and follow-up or are
already present immediately
postoperatively. In the present study we will try to answer these questions.

The objective of the present study is the evaluation of ventricular function in
patients with congenital heart defects by means of newly developed
echocardiographic techniques as tissue doppler and speckle traking stran rate
echocardiography. Since we will study patients both before surgical correction
as well as afterwards the influence of the operation with cardiopulmonary
bypass can be studied. By means of studies obtained 3 months later we can
differentiate between effects that are temporarily present after operation and
long-term effects.

We will perform detailed echocardiography including tissue doppler and speckle
tracking strain rate in patients before and after surgical correction of their
congenital heart defect. Patients will be studied before the surgical
correction, 1 and 3 days afterwards, and 1 week and 3 months later. Both
diastolic and systolic function will be studied.

All echocardiographic studies will be performed in patients that otherwise had
to undergo these studies as well. Since in the present study we will measure
some extra parameters, this will increase the time of each echocardiographic
study by 5-10 minutes. Since all echocardiographic studies are completely
noninvasive these extra minutes will be associated with only minimal burden.