Pediatric Cardiology Fellow Central Michigan University Children's Hospital of Michigan Detroit, Michigan, United States
Abstract: Introduction Atrial septostomy is frequently performed to reduce left atrial and left ventricular hypertension in patients with dilated cardiomyopathy (DCM) while supported by extracorporeal membrane oxygenation (ECMO). However, data on the acute effect of septostomy on left ventricular function is lacking. Our aim was to evaluate the effect of atrial septostomy on left ventricular function in children with DCM on ECMO.
Methods This was a retrospective study of patients with DCM between the ages of 0 to 18 years who underwent atrial septostomy in the last 22 years at our center. Patient data was collected from one echocardiogram before and two echocardiograms after septostomy. A single observer blinded to clinical data measured shortening fraction (FS) by M-mode in short axis, aortic valve velocity-time integral (VTI), myocardial performance index (MPI), and sphericity index (SI) in systole and diastole. Ejection fraction (EF), global longitudinal strain for endocardium (GLSendo) and myocardium (GLSmyo), and postsystolic shortening (PSS) were measured using vendor-independent software (TomTec Imaging, Inc.). Statistical analysis was performed using repeated measure ANOVA to compare echocardiographic parameters across the three time points. A p value of less than 0.05 was considered significant.
Results Thirteen patients met inclusion criteria, 9 (69%) of which were male with a mean age of 5.77 years (standard deviation ±6.29, median 2.34, range 0.39-18.59 years) at the time of atrial septostomy. There was a significant decrease in the FS (13.82 ± 6.59 to 4.43 ± 3.92), GLSmyo (-3.14 ± 1.74 to -2.04 ± 1.00), GLSendo (-3.94 ± 2.20 to -2.44 ± 1.22), and EF (14.82 ± 7.81 to 6.57 ± 4.88) and a significant increase in MPI (0.50 ± 0.18 to 0.95 ± 0.34) from preintervention to postintervention. FS, GLSmyo, GLSendo, EF, and MPI improved to preintervention levels by the second postintervention echocardiogram (14.44 ± 14.69, -4.34 ± 2.99, -5.76 ± 4.22, 15.97 ± 13.50, and 0.45 ± 0.37, respectively).
Conclusions A significant decrease in left ventricular function was seen early after atrial septostomy in children with DCM supported by ECMO. However, function improved to preintervention levels by the second postintervention echocardiogram. A multicenter study with a larger patient population and clinical data is necessary to better assess the effect of septostomy on left ventricular function and its clinical significance in this rare entity.
