Left Ventricular Function
Presentation on echocardiographic assessment of LV function
LV dysfunction in neonatal Permanent Junctional Reciprocating Tachycardia
Infant who had episodes of protracted arrhythmias secondary to PJRT with residual LV dysfunction in A5C, A2C and A4C.
LV dysfunction in a term newborn with HIE on therapeutic hypothermia
Parasternal long axis view indicating poor LV contractility.
Parasternal long axis view indicating poor LV contractility and some mitral regurgitation. Infants with perinatal depression often have some degree of myocardial ischemia. Subendocardial ischemia may manifest as papillary muscle ischemia and mitral insufficiency.
One can notice that the colour box, which filters for velocities above 77 cm/s, is not filled despite a colour gain at 40%, potentially indicating low blood flow velocities generated by this LV with dysfunction.
Premature newborn with asphyxia, RDS and hypoxic respiratory failure
Parasternal short axis demonstrating some degree of LV performance anomaly (moderate to severe). The flow through the aortic valve is almost completely filtered at a Nyquist of 68 cm/second, indicating that the systolic dysfunction impairs flow velocity generation in the outflow tract (possibly with secondary decreased output).
Significantly altered contractility of the LV
Parasternal short axis view.
Other structural causes of cardiac dysfunction were rule out: coronaries were evaluated with 2D and Colour (not presented) and were normal. Aortic arch did not show any signs of obstruction. LVOT was unobstructeded.
Sweep in parasternal short axis indicates that the apex seems to be more affected than the papillary area and base.
Degree of biventricular dysfunction with a depressed TAPSE.
Isosystemic pulmonary pressures by TR jet velocity (55 RV-RA gradient). The PFO was bidirectional.
LV dysfunction in A2C
Unobstructed LV outflow tract. This patient also has some mild MR and TR, indicating some suffering of the underlying ventricle during the asphyxiated event (papillary muscle subendocardial ischemia)
Bidirectional PDA from isosystemic pulmonary pressure (PVR) and possibly decreased LV output from LV dysfunction.
Altered TDI profile, with S' depressed for both ventricles.
Mild to moderate mitral regurgitation in the apical 4 chamber view
Some degree of LV dysfunction in A4C
Moderate dysfunction in the A2C
Depressed Ejection fraction by Speckle Tracking echocardiography
Abnormal strain (deformation) using speckle tracking echocardiography for the LV.
Case of biventricular dysfunction in the context of HIE
Echocardiography on day 1 - "normal" BP (mean BP 45)
Parasternal long axis outlining that the LV function (systolic) is depressed. The Aortic valve is opening and closing. There is no obvious LV hypertrophy or LVOT obstruction.
PLAX with posterior sweep outlining the tricuspid valve and RV inflow. One may appreciate that the myocardium of the RV does not seem to shorten during systole (or even thickening seems impaired).
Sweep from base to Apex. The parasternal short axis demonstrates that there is LV systolic dysfunction. The pulmonary valve opens and closes.
One may appreciate the RCA in B-mode. We also can appreciate that there is no obvious RVOT obstruction. The pulmonary valve opens and closes.
Visualization of the LCA in appropriate configuration. This is not explained by ALCAPA
Biventricular dysfunction. The RV is hypertrophied and the apex is trabeculated.
Sweep from posterior to anterior. Normal configuration of great vessels. Inflow valves are opening and closing.
RV focus view outlining moderate RV dysfunction.
RV FAC is decreased at 19%
LV focuse view. Colour shows that there is some mild mitral insufficiency, possibly from subendocardial ischemia to the papillary muscles (proxy that this LV has suffered an event of perinatal asphyxia).
TAPSE is depressed at 3 mm
dp-dt of the MR < 1200 mmHg/s (at 844) outlining LV dysfunction (systolic).
Flow is laminar via the LVOT. There is no LVOT obstruction. One may also appreciate the eccentric mitral insufficiency jet.
LVOT - VTI (stroke distance) is depressed. This outlines the resulting depressed LV output.
TDI of the RV free wall.
Depressed RVOT-VTI (decreased stroke distance and output)
LV lateral wall and septal wall with depressed systolic peak velocities by tissue doppler imaging.
Depressed EF by Simpson's in A4C (33%)
Shortening fraction is depressed at 18%. No signs of significant hypertrophy.
There may be some early indicator of LV diastolic dysfunction with a low E/A ratio
No obvious coarctation with appropriate aortic caliber and laminar flow. A restrictive PDA may be observed (bidirectional in nature, although not fully appreciated from these clips).
Decreased VTI in the descending Aorta from the depressed LV output.
Echocardiography after Epinephrine IV
Improved biventricular function in A4C (EF: 57%, FAC 37%)
At a Nyquist of 77, nice laminar flow through the LVOT into the Ascending Aorta.
Mild TR - indicating some residual RV strain
PDA small and almost closed - bidirectional
One may observe in the subcostal view the UVL at the IVC-RA junction, some degree of free fluid below the diaphragm.
Some pericardial fluid is observed in this PSAX view.
Some mild mitral insufficiency from the residual subendocardial ischemia to the papillary muscles of the mitral valve.
Adequate subjective RV and LV function by A4C view.
Sweep in the PSAX: flattening of the septum in systole (iso-systemic PA pressure), some degree of RV dilation
RV looks similar in size to the LV. there is adequate RV function.
Normalized RV TDI.
Although angulated, one may appreciate the low-normal systolic velocity of the LV free wall (5th beat being the clearest)
Improved VTI in the descending abdominal aorta.
Improvement in the Shortening fraction, although there is paradoxical movement of the inter-ventricular septum from the isosystemic pulmonary pressure.
Echocardiography on day 2 - after addition of Milrinone IV
Improved LV and RV function on the A4C
Good flow via pulmonary veins. No significant mitral insufficiency.
Good left ventricular function with some flattening of the septal curve
E/A = 1
TAPSE has normalized
Systolic velocity of RV has normalized
Improved LV free wall systolic velocity
Improved LV septal systolic velocity
Some paradoxical movement of septum on the M-Mode (PSAX). Overall good movement of the LV posterior wall. E-seperation point normal.
Lung ultrasound - showcasing some degree of free fluid around the heart.
Neonatal Heart Failure and Cardiomyopathy by Dr Alami
Presented at the McGill Neonatal Conference 2022