Predicting postoperative hypertension among patients with ventricular
septal defect in infants.
Abstract
Background: Patients with strong pulmonary vascular occlusive lesions
are at risk of developing postoperative pulmonary hypertension (PH). We
aimed to evaluate preoperative right ventricular (RV) function in
patients with ventricular septal defect (VSD) who required cardiac
surgery during infancy and consequently developed postoperative PH and
to determine whether we could preliminarily evaluate postoperative PH in
these patients. Methods: We retrospectively analyzed 55 infants with VSD
who underwent cardiac surgery between March 2014 and April 2020. We
evaluated the measurements of preoperative general function and 2D
strain between these two groups: a group with postoperative PH (post-PH,
n=10) and a group without postoperative PH (post-NPH, n=45). Results:
Post-PH patients had a significantly lower tricuspid annular plane
systolic excursion (TAPSE) (11.1 mm), TAPSERA (the proportion of TAPSE
due to right atrial (RA) contraction alone) (7.0 mm), RA ejection
fraction (36.1 %) and RA expansion index (56.4 %) than the post-NPH
patients. Furthermore, the post-PH group had a significantly lower peak
RA longitudinal strain (PRALS) (32.0 %) than the post-NPH group
(43.0%). Multivariate logistic regression model demonstrated that PRALS
was independent echocardiographic parameters for the presence of post-PH
(OR 1.18, 95% CI: 1.02 - 1.36, p = 0.03) . The sensitivity and
specificity of predicting post-PH for ≤ 35 % of the PRALS were 88.9 %
and 70.0 %, respectively, with an area under the curve of 0.85 (p
< 0.01). Conclusion: RA parameters demonstrated preoperative
RV diastolic dysfunction in the post-PH group. PRALS could be useful
factors for predicting postoperative PH.