Pediatric Cardiology and Cardiac Surgery
Vol.27 No.5 2011 (242-248)

Naoki Kuwabara1), Kentaro Omoya1), Hiroko Goto1), Atsushi Kaneko1), Atsushi Terasawa1), Takashi Kuwahara1), Masahiro Okura2, 3), Mio Noma2), Yusuke Iwata2), Masataka Takeuchi2)

1)Department of Pediatric Cardiology and 2)Pediatric Cardiac Surgery, Gifu Prefectural General Medical Center, Gifu, Japan, 3)Department of Cardiovascular Surgery, Tokyo Women’s Medical University, Tokyo, Japan


We reported two patients (1-year-old boy and 1-year-old girl) with dilated cardiomyopathy who underwent cardiac resynchronization therapy (CRT), of which optimal pacing sites were determined by speckle-tracking strain analysis using transesophageal echocardiography (TEE) during pacemaker implantation. After measuring the timing of the speckle-tracking peak radial strain in a short-axis view of the left ventricle at the level of the papillary muscles, we determined that the most delayed segment was the appropriate left ventricle lead position. Second, the right ventricle lead position was determined by the point where minimum dispersion among each segment resulting from biventricular pacing was obtained. By means of a speckle-tracking strain analysis using TEE, we repeatedly evaluated dyssynchrony by fixed probe position without disturbing the surgeon. The clinical findings in both patients after CRT were markedly improved. Some patients who underwent CRT might not improve due to an inappropriate pacing site. In children, it was useful to evaluate mechanical dyssynchrony by using TEE during surgery since the pacing points can be selected from any point.