Department of Pediatrics, Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of NewYork Presbyterian/Columbia University Irving Medical Center, New Haven, Connecticut, USA.
Department of Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, New York, New York, USA.
Echocardiography. 2022 Feb;39(2):178-184. doi: 10.1111/echo.15274. Epub 2022 Jan 11.
The ratio of early diastolic mitral inflow velocity (E) to early diastolic mitral annular tissue velocity (e'), or E/e', is an echocardiographic measure of left ventricular filling pressure. Peri-operative changes in E/e' and association with outcomes have been demonstrated in adults undergoing surgery for aortic stenosis (AS). We sought to explore changes in E/e' and other diastolic indices in the setting of congenital AS surgery and to assess for association with post-operative outcomes among children and young adults.
A retrospective, single-center study was performed among patients 6 months to 30 years of age who underwent congenital AS surgery from 2006 to 2018. Tissue Doppler indices were collected from pre- and post-operative echocardiograms. Post-operative outcomes were reviewed.
Sixty-six subjects with subvalvar (45%), valvar (47%), and supravalvar (8%) AS underwent surgery at a median age of 9.5 years (IQR: 4.0-14.8). Pre-operatively, the lateral E/e' ratio was 8.6 (6.7-11.0); 33% had E/e'≥10. Post-operatively, the lateral e' decreased to 9.9 cm/s (8.0-11.4), the E/e' ratio increased to 10.4 (8.3-13.1); and 53% had E/e'≥10 (p-values < 0.0001, 0.0072, and < 0.001, respectively). Pre-operative lateral e' correlated modestly with duration of intubation (ρ = -0.24, p-value 0.048) and post-operative lateral e' correlated modestly with duration of intubation and length of hospital stay (ρ = -0.28 and -0.26, p-values = 0.02 and 0.04, respectively).
Children and young adults who underwent congenital AS surgery had echocardiographic evidence of diastolic dysfunction pre-operatively that worsened post-operatively. Lateral e' may be a sensitive indicator of impaired ventricular relaxation in these patients and may impact duration of intubation and hospital stay.
早期舒张二尖瓣血流速度（E）与早期舒张二尖瓣环组织速度（e'）的比值（E/e'）是一种超声心动图测量左心室充盈压的方法。在接受主动脉瓣狭窄（AS）手术的成年人中，已经证明了围手术期 E/e'的变化及其与结局的关系。我们试图探讨先天性 AS 手术中 E/e'和其他舒张指数的变化，并评估其与儿童和年轻成人术后结局的关系。
对 2006 年至 2018 年间接受先天性 AS 手术的 6 个月至 30 岁患者进行了一项回顾性单中心研究。从术前和术后超声心动图中收集组织多普勒指数。审查了术后结果。
66 名患者患有瓣下（45%）、瓣上（47%）和瓣上（8%）AS，中位年龄为 9.5 岁（IQR：4.0-14.8）。术前，外侧 E/e'比值为 8.6（6.7-11.0）；33%的患者 E/e'≥10。术后，外侧 e'降至 9.9cm/s（8.0-11.4），E/e'比值增至 10.4（8.3-13.1）；53%的患者 E/e'≥10（p 值分别<0.0001、0.0072 和<0.001）。术前外侧 e'与插管时间呈中度相关（ρ=-0.24，p 值=0.048），术后外侧 e'与插管时间和住院时间呈中度相关（ρ=-0.28 和-0.26，p 值分别为 0.02 和 0.04）。
接受先天性 AS 手术的儿童和年轻成年人术前存在舒张功能障碍的超声心动图证据，术后恶化。外侧 e'可能是这些患者心室松弛受损的敏感指标，并可能影响插管时间和住院时间。
