Predicting Postoperative Hypertension Among Patients With Ventricular Septal Defect in Infants

Abstract Purpose: Patients with strong pulmonary vascular occlusive lesions are at risk of developing postoperative pulmonary hypertension (PH). We aimed to evaluate preoperative right ventricular (RV) function in patients with ventricular septal defect (VSD) who required cardiac surgery during infancy and consequently developed postoperative PH and to determine whether we could preliminarily evaluate postoperative PH in these patients. Methods: We retrospectively analyzed 55 infants with VSD who underwent cardiac surgery between March 2014 and April 2020. We evaluated the measurements of preoperative atrial/ventricular general function and 2D atrial/ventricular strain between these two groups: a group with postoperative PH (post-PH) and a group without postoperative PH (post-NPH). Results: Post-PH patients had a significantly lower tricuspid annular plane systolic excursion (TAPSE) (11.2 mm) and TAPSERA (the proportion of TAPSE due to RA contraction alone) (6.6 mm) than the post-NPH patients (14.1 mm, 8.5 mm). Furthermore, the post-PH group had a significantly lower peak right atrial (RA) longitudinal strain (PRALS) (31.0%) than the post-NPH group (43.0%). Multivariate logistic regression analysis identified that PRALS and TAPSERA were independent echocardiographic parameters for the presence of post-PH. The sensitivity and specificity of predicting post-PH for ≤38% of the PRALS were 83.0% and 100.0%, respectively, with an area under the curve of 0.94 (p < 0.01). Conclusion: Preoperative RA function and RV diastolic function decreased in the post-PH group. The RA strain and TAPSERA could be useful factors for predicting postoperative PH.