DETECTIION OF EARLY MYOCARDIIAL IINJURY IIN VSD PATIIENTS BY CARDIIAC TROPONIIN II AND TWO--DIIMENSIIONAL SPECKLE TRACKIING ECHOCARDIIOGRAPHY

Abstract

SUMMARY UMMARYUMMARYUMMARYUMMARY entricular septal defect (VSD) is the most common congenital heart defect and the most common cause of heart failure in children, especially in infants (Wu et al., 2006). CTnI is associated with impaired haemodynamic, elevated BNP levels, and progressive left ventricular dysfunction in patients with HF. cTnI may be a novel, useful tool in identifying patients with HF who are at increased risk for progressive ventricular dysfunction and death Tamara et al, 2003 Speckle-tracking echocardiography is a new non-invasive ultrasound imaging technique that allows for an objective and quantitative evaluation of global and regional myocardial function independently of the angle of insonation and the cardiac translational movements (Blessberger et al., 2010 & Sergio et al., 2011). The aim of this work is to detect early myocardial injury in VSD patients using serum CTnI level and 2D speckle tracking echocardiography. This study was performed at the pediatric cardiology clinic and echocardiography unit, childrens hospital, Ain Shams University from April 2012 to December 2013 on 30 patients with isolated VSD. V  Summary 165 All patients were subjected to the following:  Full history taking laying stress on symptoms of heart failure and chest infection.  Thorough clinical examination laying stress on signs of heart failure, pulmonary hypertension and chest infection.  Assessment of serum cTnI level.  Chest X-ray to assess cardiomegaly and concurrent chest infection.  Routine 2D echocardiography to delineate the anatomy of the VSD, cardiac chamber dimensions, presence of pulmonary hypertension and to exclude other congenital heart defects. M mode echocardiography to assess the left ventricle dimension and systolic function. Also continuous, pulsed, color Doppler echocardiography and 2D speckle tracking echocardiography to evaluate myocardial function (global and regional) using a commercially available cardiac ultrasound unite, by using device model (vivid E9 GE vingmed ultrasound A/S N-3191 Horten Norway). Weight, BSA and BMI showed statistically significant difference between compensated and decompensated groups and  Summary 166 control group. While sex, age and height detected no statistically significant difference between all groups. 26 patients (86.67%) had sub aortic perimembranous VSD, 3 patient (10%) had mid muscular VSD, while only 1 patient (3.33%) had sub pulmonary VSD. 17 patients (56.67%) had moderate size VSD, 9 patients (30%) had small size VSD, and 4 patients (13.67) had large size VSD based on the relation to the aortic root diameter. The mean values of the VSD size among the decompensated group was higher (0.62±0.2) cm when compared to the compensated group (0.47±0.17) cm and that the difference was statistically significant.