Preoperative Echocardiographically Derived Mean dP/dTic Predicts Early Post-operative Dysfunction in Children Undergoing Mitral Valve Surgery

Abstract

Background Mean dP/dt_ic is a quantitative measurement of ventricular function that can be obtained noninvasively by echocardiography. In adults with mitral regurgitation (MR) it has been shown to be a more sensitive predictor of post-operative left ventricular ejection fraction (EF). The utility of dP/dt_ic in pediatric congenital heart diseases with MR has been underexplored. Methods Patients (0 to ≤ 19 years) with MR who underwent mitral valve (MV) repair or replacement from 2015 to 2021 were included. Echocardiographically derived mean dP/dt_ic, Tei index, and EF were used to assess and compare ventricular function prior to, shortly after, and late after MV surgery. Results Study cohort included 61 patients (age 4.5 [IQR 0.14, 18.7] years, 89% MV repair, 11% MV replacement). Median time intervals between surgery and preoperative, early postoperative, and late postoperative echocardiograms were 6 days, 6 days, and 350 days, respectively. Median EF was 62% (z-score − 0.40) preoperatively, 56% (z-score − 1.40) early postoperatively, and 61% (z-score − 0.60) late postoperatively. Median dP/dt_ic was 1393 (IQR 1029, 1775) mmHg/s preoperatively, 1178 (IQR 886, 1946) mmHg/s early postoperatively, and 1270 (IQR 791, 1765) mmHg/s late postoperatively. Preoperative median dP/dt_ic correlated with early and late postoperative EF. Preoperative EF was not significantly correlated with early postoperative EF, but was correlated with late postoperative EF. Conclusions Mitral valve intervention in pediatric patients is associated with an initial decline but long-term recovery of systolic function. Non-invasively derived mean dP/dt_ic may offer advantages over other preoperative echocardiographic indices to predict postoperative systolic function.