Perioperative assessment of myocardial work in children undergoing ventricular septal defects closure - 27/08/26
, Comme Schmitt 1, Paul Vignaud 1, Aitor Guitarte 1, Yves Dulac 1, Philippe Acar 1, Khaled Hadeed 1, Montserrat Sierra-Colomina 2, Clement Karsenty 1Résumé |
Introduction |
Myocardial work (MW) is an emerging echocardiographic parameter that integrates myocardial deformation with afterload, providing a more comprehensive assessment of ventricular performance than traditional load-dependent parameters. While its clinical value has been increasingly investigated in adults, data in the pediatric population remain limited. We aimed to evaluate perioperative changes in left and right ventricular MW and to explore their association with perioperative status.
Methods |
Eighteen consecutive children undergoing surgical ventricular septal defect (VSD) closure at a single center between January and April 2025 were prospectively evaluated. Echocardiographic assessment was performed preoperatively, within 24 hours postoperatively, and at hospital discharge.
Results |
Median age was 29.9 months (range: 3.3–135.4; IQR: 43.9), and median weight was 8.4 kg (range: 5.1–26.0; IQR: 4.9).
Left ventricular (LV) global work index (GWI) decreased from 1390.0 mmHg% (range: 899.0–1837.0; IQR: 479.0) preoperatively to 780.5 mmHg% (range: 210.0–1983.0; IQR: 297.5) postoperatively and 849.0 mmHg% (range: 204.0–1423.0; IQR: 250.5) at discharge. Right ventricular (RV) GWI decreased from 531.0 mmHg% (range: 217.0–1032.0; IQR: 427.5) preoperatively to 216.0 mmHg% (range: 105.0–555.0; IQR: 103.5) postoperatively and 220.0 mmHg% (range: 121.0–404.0; IQR: 88.5) at discharge. The decrease was significant for both ventricles compared with baseline ( P < 0.0001), while the difference between post-op and discharge was not statistically significant. Early postoperative RV GWI correlated with cardiopulmonary bypass (CPB) duration ( r = 0.53, P = 0.03) and pediatric index of mortality 3 (PIM 3) score ( r = 0.63, P = 0.007), whereas LV MW showed no significant associations ( Fig. 1 ).
Conclusion |
In children undergoing VSD repair, MW and systolic biventricular function decrease in the postoperative period. Early postoperative RV GWI was associated with markers of perioperative burden, such as CPB duration and PIM 3 score. These observations highlight the need for further investigation in larger pediatric cohorts.
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Vol 119 - N° 8-9S
P. S258 - août 2026 Retour au numéro
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