Abnormal left ventricular filling after neonatal repair of congenital heart disease: Association with increased mortality and morbidity

Background The presence of mid-diastolic flow reversal on the mitral valve Doppler inflow indicates abnormal left ventricular Filling. To determine wh ether mid-diastolic flow reversal predicts outcome in patients undergoing r epair or palliation of neonatal congenital heart disease, we reviewed the e chocardiograms and medical records of 40 patients with either left ventricu lar outflow obstruction or transposition of the great arteries. Methods All patients underwent surgical repair; transposition of the greet arteries (TGA) = 17, coarctation of the aorta (CoA) = 14, interrupted aorti c arch (IAA) = 8, and aortic stenosis (AS) = 1. The presence of mid-diastol ic flow reversal was determined by pulsed Doppler interrogation of the mitr al valve on preoperative and postoperative echocardiograms. Results Preoperative echocardiograms showed diastolic flow reversal in only 5 patients; 1 of 1 with AS and 4 of 14 with CoA. Twenty-one of 40 patients showed postoperative diastolic flow reversal; 1 of 1 with AS, 8 of 8 with IAA, 1 of 14 with CoA, and 11 of 17 with TGA. Postoperative mid-diastolic f low reversal 1 to 3 days after surgery was associated with higher mortality rate: 7 of 21 patients with diastolic flow reversal and 0 of 19 without di astolic flow reversal died. Patients with diastolic flow reversal who survi ved had longer intensive care unit (26.2 +/- 13.5 days vs 7.1 +/- 4.1 days, P < .001) and hospital (57.4 +/- 38.8 days vs 14.8 +/- 5.2 days, P < .05) stays. Conclusion Mid-diastolic flow reversal is an indicator of prolonged hospita l stay and mortality in patients with left ventricular outflow tract obstru ction or TGA.