OBJECTIVE We aimed to assess the change in global and regional myocardial function before and after surgical revascularization and their added value when compared with conventional measures in children with anomalous left coronary artery from the pulmonary artery (ALCAPA). METHODS Advanced echocardiographic assessment was performed pre- and postoperatively in 22 children with ALCAPA (eight male; median surgery age, 0.4 years; interquartile range, 0.21-1.05) and 22 healthy controls. Measurements included global and segmental longitudinal, radial, and circumferential two-dimensional speckle-tracking strain and postsystolic index. RESULTS Global strains were lower in preoperative patients than in controls (longitudinal: -9% vs -21%; P < .001; circumferential: -11% vs -21%; P < .001; radial: 18% vs 60%; P < .001) and improved postoperatively when compared with preoperative findings (longitudinal: -9% pre vs -16% post; P = .002, circumferential:-11% pre vs -17% post; P = .012, radial: 18% pre vs 53% post; P = .001). Preoperatively, patients with normal global systolic function on conventional echocardiography had significantly impaired global longitudinal and radial strain compared with healthy controls. Global mechanical dyssynchrony improved significantly postoperatively (longitudinal postsystolic index 43 pre vs 6 post, P < .001; circumferential 15 pre vs 2 post, P = .001; radial 48 pre vs 5 post, P = .003). Despite overall improvement in most segments, global longitudinal and circumferential and segmental peak strain in some of the segments supplied by the ALCAPA remained postoperatively abnormal. CONCLUSIONS This study shows that myocardial deformation indices were a more sensitive measure of LV dysfunction in patients before and after ALCAPA repair than conventional echocardiographic measures. We believe, therefore, they should be added to routine preoperative and serial postoperative follow-up assessment.

中文翻译：

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儿童肺动脉左冠状动脉异常起源修复后的心肌功能。

目的：我们的目的是评估在肺动脉异常左冠状动脉 (ALCAPA) 患儿中，与常规措施相比，手术血运重建前后整体和区域心肌功能的变化及其附加值。方法 对 22 名 ALCAPA 儿童（8 名男性；中位手术年龄，0.4 岁；四分位距，0.21-1.05）和 22 名健康对照者在术前和术后进行了高级超声心动图评估。测量包括全局和节段性纵向、径向和圆周二维斑点追踪应变和收缩后指数。结果 术前患者的整体应变低于对照组（纵向：-9% 对 -21%；P < .001；圆周：-11% 对 -21%；P < .001；径向：18% 对 60%； P < 。001) 并且与术前结果相比在术后有所改善（纵向：-9% 前 vs -16% 后；P = .002，周向：-11% 前 vs -17% 后；P = .012，径向：18% 前对比 53% 的帖子；P = .001）。术前，与健康对照相比，常规超声心动图显示整体收缩功能正常的患者整体纵向和径向应变明显受损。术后整体机械不同步显着改善（纵向收缩后指数 43 前 vs 6 后，P < .001；圆周 15 前 vs 2 后，P = .001；径向 48 前 vs 5 后，P = .003）。尽管大多数节段总体上有所改善，但 ALCAPA 提供的某些节段的整体纵向和周向以及节段峰值应变在术后仍然异常。结论 本研究表明，与传统的超声心动图测量相比，在 ALCAPA 修复前后，心肌变形指数是一种更敏感的左室功能障碍测量指标。因此，我们认为应该将它们添加到常规的术前和连续的术后随访评估中。