Ventricular mechanics after repair of subarterial and perimembranous VSDs

Abstract

Background: Emerging data suggest impaired biventricular function in adults late after repair of ventricular septal defect (VSD). We assessed and compared right (RV) and left ventricular (LV) mechanics in adolescents and adults after surgical closure of doubly committed subarterial and perimembranous VSDs. Methods: A total of 75 subjects were studied: 29 patients after subarterial VSD repair (group I), 17 patients after perimembranous VSD repair (group II) and 29 age-matched controls (group III). RV and LV mechanics were assessed using tissue Doppler and speckle-tracking echocardiography, while RV outflow systolic function was quantified by systolic excursion and fractional shortening (FS). Results: Compared with group III, groups I and II had significantly reduced tricuspid annular systolic and diastolic velocities, isovolumic myocardial acceleration, RV global longitudinal systolic and diastolic deformation parameters and RV outflow systolic excursion (all P <.05). Group I, but not II, had reduced RV outflow FS (P =.008) and the lowest global LV longitudinal systolic strain (P =.008) and systolic strain rate (P =.014). In group I, postoperative aortic regurgitation was associated with lower LV longitudinal systolic strain (P =.009) and early diastolic strain rate (P =.002), while right bundle branch block was associated with lower RV systolic strain rate (P =.048). As a group, RV outflow excursion (P <.001) and FS (P =.001) were correlated with LV global systolic strain. Conclusion: Adolescents and adults late after repair of subarterial and perimembranous VSDs show impairment of RV systolic and diastolic myocardial deformation. The RV outflow function and LV systolic deformation appear to be worse after repair of subarterial defects.