Speckle Tracking Echocardiography in Congenital Heart ... · Speckle Tracking Echocardiography in...
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Speckle Tracking Echocardiography in Congenital Heart Disease – Transposition of Great Arteries
R. Marinov, St. Georgiev, Kr. Hristova
National Heart Hospital – Sofia, Bulgaria
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Cross-point? GUCH patients!
Cardiology
Many patients
Big experience
Good cardiosurgery
Many innovations; tehnology
Pediatric cardiology
Different CHD
Variable hemodynamics
Difficult cardiosurgery
Different thinking
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What is TGA?
Not uncommon - 8% of CHD.
Potentially lethal without treatment
Treatment is surgery!
Two possible operations:
Atrial switch - Senning–Brom – 1964-1985-Physiological correction;
Arterial switch - anatomic correction- 1980-............
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What is TGA? TGA Senning Arterial switch
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Senning Operation
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Anatomic characteristics of the systemic RV
Relatively small papillary muscles
Hypokinetic part – infundibulum
Systolic movement of septum towards LV
Abnormal volume load
Different coronary perfusion
Different structure of the wall
Potentially dysfunctional
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Long-term problems after Senning operation - pathophysiology
Long-term volume overload
Ischemia
Fibrosis and remodeling of RV
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RV Volume
Post Senning Normal heart
N.Poirier-J.Th.Cardiovasc.Surg.2004
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Long-term problems after Senning operation
Systemic venous or pulmonary venous obstruction
RV- Dysfunction
TR
Arrhythmias
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Diagnostic methods for RV
Еchocardiography
Conventional echo
TDI strain, strain rate
Speckle tracking strain and strain rate
3D
MRI – reference method
Perfusion scyntigraphy
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Strain as a marker of deformation
Strain represents myocardial deformation and strain rate represents
the rate at which this deformation takes place.
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Speckle tracking
Two-dimensional (2D) strain is based on comparison of the image texture from frame to frame. The distortion of this pattern permits assessment of strain in the axis of movement rather than the axis of the ultrasound beam.
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Key parts of the right ventricle
inlet
infundibulum base
equator
apex
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STE - validation in pediatric patients LV
Cardiovasc.Ultrasound 2009 7:8
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STE - validation in pediatric patients- RV
Pren. diagnosis – 2010 p1057-1063
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MRI
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2012; in Press
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Cutoff -10%
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Speckle tracking derived strain – clinical applications
Supports decision making in: Heart failure therapy Further investigation (Cath., MRI) Re-operation: tricuspid valve repair conversion to arterial switch
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Conclusion
Patients after Senning op. have significantly reduced RV strain, and it correlates with MRI derived EF.
RV Strain < -10% correlates with adverse outcome in patients after Senning OP.
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Arterial switch operation
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Arterial switch– late complications
RV outflow tract obstruction
LV outflow tract obstruction
Ао regurgitation
Epicardial coronary artery stenosis
Perfusion defects
Wall motion abnormalities
Dysrhythmia
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40% of arterial switch patients have scyntigraphy perfusion defects, undetected by angiography. All of them have regional wall motion abnormality due to microcirculatory disturbances
E.Basha –BChH. 2008
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Abnormal microcirculation
Progressive intimal proliferation due to coronary translocation
Denervation of coronary arteries in the operation
Frequently abnormally high origin of the coronary arteries
Reduced coronary flow reserve
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Late myocardial ischemia after Arterial switch operation is
asymtpomatic because of coronary intraoperative denervation!
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Coronary circulation- evaluation
Perfusion scintigraphy
MRI
Heart catheterization
Еchocardiography - STE?
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STE strain and strain rate after arterial switch – our study …
09.2011 – ongoing
58 arterial switch patients
1-18 years old
17 healthy controls
STE – offline analyze by Siemens-Syngo US Workplace VVI
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P<0,05
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P<0,05
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Considerations
Strain adds information regarding systolic function of LV and RV in patients after arterial switch.
Microcirculatory coronary abnormalities result in regional wall dyskinesia.
Potential clinical applications of STE strain in patients with congenital heart disease have to be further evaluated.
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