The Assessment of Myocardial Performance and the Impact of Pathological Processes on Cardiac Adaptation in the Neonatal Population using Functional Echocardiography
thesisposted on 05.08.2020 by Colm Breatnach
In order to distinguish essays and pre-prints from academic theses, we have a separate category. These are often much longer text based documents than a paper.
Introduction: Functional echocardiography is a rapidly expanding field in both research
and clinical settings. Newer techniques facilitate comprehensive and objective
assessments of myocardial performance not previously possible. Although work has been
done to assess feasibility and obtain reference values for several new modalities in
normal term and preterm infants, data is still lacking in several important disease states.
Objectives: We aim to study the impact of several important conditions on neonatal
myocardial function over the transitional period. We hypothesise that myocardial function
is impaired in certain conditions and that novel echocardiography techniques could
improve our ability to characterise disease severity and predict important outcomes.
Methods: We recruited several cohorts of infants including: control preterm and term
infants; preterm infants with haemodynamically significant ductus arteriosus and chronic
lung disease; infants with hypoxic ischemic encephalopathy; monochorionic diamniotic
twins with twin to twin transfusion; and infants with Down syndrome with structurally
normal hearts. We performed three echocardiograms on Day 1 (6-12 hours), Day 2 (36-
48 hours) and Day 5 – 7. We compared our results in disease patient cohorts with a
cohort of healthy preterm and term infants.
Results: We have characterised myocardial performance in: preterm infants with and
without disease; healthy term infants; infants with hypoxic ischemic encephalopathy;
monochorionic diamniotic twins with and without twin to twin transfusion syndrome; and
infants with Down syndrome with structurally normal hearts. We have demonstrated
changes in haemodynamic status and cardiac function in these conditions and provided a
rationale for these changes, in addition to exploring markers of outcome predication.
Conclusion: Several important neonatal conditions affect myocardial performance during
the transitional period. An improved understanding of cardiac function can aid in our
ability to predict outcome and monitor disease. In the future, functional echocardiography
may act to guide intervention and improve our management of these patients.
First SupervisorProfessor Afif El-Khuffash
Second SupervisorDoctor Orla Franklin
Third SupervisorProfessor Naomi McCallion
CommentsA thesis submitted for the degree of Doctor of Philosophy from the Royal College of Surgeons in Ireland in 2018.
Published CitationBreathnach C. The Assessment of Myocardial Performance and the Impact of Pathological Processes on Cardiac Adaptation in the Neonatal Population using Functional Echocardiography [PhD Thesis]. Dublin: Royal College of Surgeons in Ireland; 2018
Degree NameDoctor of Philosophy (PhD)
Date of award30/06/2019
- Doctor of Philosophy (PhD)