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Background <p>Early postoperative left ventricular (LV) dysfunction commonly occurs after ventricular septal defect (VSD) repair in paediatric patients. This study aimed to investigate its risk factors and impact on follow-up cardiac functional status.</p> Methods <p>We retrospectively enrolled patients with preserved LV ejection fraction (LVEF) ≥ 55% undergoing isolated surgical VSD repair. Early postoperative LV dysfunction was defined as LVEF &lt; 55% during hospitalisation. LV function parameters including myocardial strain and work were obtained. Cardiac functional recovery was assessed at 1, 3, 6, and 12 months post-discharge based on Ross Classifications.</p> Results <p>The cohort comprised 409 patients (3.00 [1.00–5.75] years; 50.4% male), with 82 (20.05%) developing postoperative LV dysfunction. Multivariate analysis showed that preoperative LV global longitudinal strain (LV GLS), global work index (LV GWI), global work efficiency (LV GWE), LV end-diastolic volume index (LVEDVi), moderate-to-severe sPAP, and large VSD size, as well as prolonged cardiopulmonary bypass (CPB) time, were significantly associated with postoperative LV dysfunction (all <i>p</i> &lt; 0.05). ROC analyses found that integrating LV GWI and GWE with clinical parameters (LVEDVi, VSD size, or sPAP) enhanced prediction (AUC 0.848–0.883, <i>P</i> &lt; 0.001). During follow-up, patients with postoperative LV dysfunction exhibited less favourable Ross classification recovery at 12 months after surgery.</p> Conclusions <p>Myocardial strain and work indices were related to early postoperative LV dysfunction in paediatric patients after isolated VSD repair, which was correlated with persistent symptoms and cardiac dysfunction at 12-month follow-up. Pre- and postoperative LV function assessment may offer useful information for managing this patient population.</p> Registration <p><a href="https://www.chictr.org.cn/">https://www.chictr.org.cn/</a>; Unique identifien ChiCTR2400092501 Retrospectively registered 18 November 2024.</p> Graphical abstract <p></p>

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Predictors and outcomes of early left ventricular dysfunction in paediatric patients postoperative for ventricular septal defect: a retrospective cohort study based on myocardial strain and work

  • 期刊论文

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  • 发表日期：

    2026年8月1日

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  • Wanyu Zhao,
  • Weijun Li,
  • Tao Wang,
  • Lang Gao,
  • Jinnan Zhang,
  • Qiuzhe Guo,
  • Yifei Zhang,
  • Lulu Zhang,
  • Shuanglan Yu,
  • Xiaoli Dong,
  • Jingjin Wang,
  • Zhiling Luo

摘要

Background

Early postoperative left ventricular (LV) dysfunction commonly occurs after ventricular septal defect (VSD) repair in paediatric patients. This study aimed to investigate its risk factors and impact on follow-up cardiac functional status.

Methods

We retrospectively enrolled patients with preserved LV ejection fraction (LVEF) ≥ 55% undergoing isolated surgical VSD repair. Early postoperative LV dysfunction was defined as LVEF < 55% during hospitalisation. LV function parameters including myocardial strain and work were obtained. Cardiac functional recovery was assessed at 1, 3, 6, and 12 months post-discharge based on Ross Classifications.

Results

The cohort comprised 409 patients (3.00 [1.00–5.75] years; 50.4% male), with 82 (20.05%) developing postoperative LV dysfunction. Multivariate analysis showed that preoperative LV global longitudinal strain (LV GLS), global work index (LV GWI), global work efficiency (LV GWE), LV end-diastolic volume index (LVEDVi), moderate-to-severe sPAP, and large VSD size, as well as prolonged cardiopulmonary bypass (CPB) time, were significantly associated with postoperative LV dysfunction (all p < 0.05). ROC analyses found that integrating LV GWI and GWE with clinical parameters (LVEDVi, VSD size, or sPAP) enhanced prediction (AUC 0.848–0.883, P < 0.001). During follow-up, patients with postoperative LV dysfunction exhibited less favourable Ross classification recovery at 12 months after surgery.

Conclusions

Myocardial strain and work indices were related to early postoperative LV dysfunction in paediatric patients after isolated VSD repair, which was correlated with persistent symptoms and cardiac dysfunction at 12-month follow-up. Pre- and postoperative LV function assessment may offer useful information for managing this patient population.

Registration

https://www.chictr.org.cn/; Unique identifien ChiCTR2400092501 Retrospectively registered 18 November 2024.

Graphical abstract