Biventricular systolic function and mass studied with MR imaging in children with pulmonary regurgitation after repair for tetralogy of Fallot.

Niezen, R A; Helbing, Willem A.; Wall, Ernst E. van der; Geest, Rob J. van der; Rebergen, Sidney A.; Roos, Albert de

doi:10.1148/radiology.201.1.8816534

Cited by 133 publications

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“…[2][3][4][5] Although it is well tolerated in the short term, it is associated with progressive exercise intolerance, ventricular dysfunction, arrhythmia, and late sudden death. [2][3][4][5] Although pulmonary regurgitation at the level of the pulmonary valve and MPA has been studied extensively, 2-4,7-10 pulmonary blood flow in the branch pulmonary arteries has not been investigated previously. The average regurgitant fraction in the present study population was greater in the LPA than in the RPA.…”

Section: Discussionmentioning

confidence: 99%

“…Chronic pulmonary regurgitation, an inevitable consequence of a transannular patch repair or pulmonary valvotomy, has become a significant determinant of late symptoms and long-term outcome, including exercise intolerance, ventricular dysfunction, arrhythmia, and the risk of sudden death. [2][3][4][5] In this regard, pulmonary valve replacement has increasingly been recommended. 6 The characteristics of pulmonary regurgitation after repair of TOF have been studied extensively by a variety of methods.…”

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confidence: 99%

“…6 The characteristics of pulmonary regurgitation after repair of TOF have been studied extensively by a variety of methods. [2][3][4][7][8][9][10] However, the contribution of each branch pulmonary artery to total pulmonary regurgitation has not been investigated. It has been reported that TOF is associated with a different geometric orientation of the branch pulmonary arteries, unequal pulmonary vascularity, and pulmonary perfusion abnormalities, each of which may independently modify the amount of pulmonary regurgitation.…”

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confidence: 99%

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Differential regurgitation in branch pulmonary arteries after repair of tetralogy of fallot: a phase-contrast cine magnetic resonance study

Kang¹,

Redington²,

Benson³

2003

ACC Current Journal Review

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Background-The importance of pulmonary regurgitation (PR) after repair of tetralogy of Fallot (TOF) is increasingly recognized, but little is known regarding its underlying mechanisms. This phase-contrast cine magnetic resonance (PC MR) study was performed to evaluate the relative contribution of each lung to total regurgitant volume. Methods and Results-Twenty-two patients with significant PR underwent a PC MR 3 to 16 years after repair of TOF.Regurgitant fraction of the main pulmonary artery was 39Ϯ10%. Regurgitant fraction of the left pulmonary artery (LPA; 46Ϯ18%) was greater than that of the right pulmonary artery (34Ϯ16%; Pϭ0.002). The average contribution of the LPA to the total regurgitant flow volume was 54Ϯ19%, whereas its average contribution to the total forward flow volume was 44Ϯ13% (Pϭ0.002). In 4 patients, regurgitant flow in the LPA accounted for 75% to 100% of the total regurgitant flow. There was a linear relationship between regurgitant fraction and fraction of the regurgitant flow duration in the main pulmonary artery (PϽ0.001) and right pulmonary artery (Pϭ0.001) but not in the LPA (Pϭ0.129). Conclusions-PR after repair of TOF is commonly associated with differential regurgitation in the branch pulmonary arteries, which is usually greater in the LPA. Although the cause of this disparity requires further investigation, those patients with a significant unilateral contribution to total PR may be amenable to localized techniques to reduce regurgitation. (Circulation. 2003;107:2938-2943.)

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Differential regurgitation in branch pulmonary arteries after repair of tetralogy of fallot: a phase-contrast cine magnetic resonance study

Kang¹,

Redington²,

Benson³

2003

ACC Current Journal Review

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“…Following surgical correction, many patients have moderate to severe pulmonary insufficiency (PI) with minimal or no residual pulmonary stenosis (PS). Chronic PI plays a pivotal role in right ventricular (RV) dilatation and dysfunction, following surgical repair of RV outflow tract (RVOT) obstruction (2)(3)(4)(5)(6)(7)(8). Most patients following surgical correction of TOF experience a prolonged asymptomatic phase.…”

Section: Introductionmentioning

confidence: 99%

CMR assessment of right ventricular function in patients with combined pulmonary stenosis and insufficiency after correction of tetralogy of Fallot

et al. 2013

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Background: Tetralogy of Fallot (TOF) is one of the most common types of congenital heart disease and requires prompt surgical correction. Post-correction pulmonary insufficiency (PI) often ensues in adulthood. At times, the PI is accompanied by residual pulmonary stenosis (PS). Little is known regarding right ventricular (RV) function in the setting of combined PS and PI. Purpose: To compare cardiac magnetic resonance (CMR) parameters for the assessment of RV function between patients with combined pulmonary stenosis and pulmonary insufficiency (PSPI) and isolated PI following surgical repair of TOF. Material and Methods: Retrospective review of patients with comparable corrected TOF and similar PI was performed. Seventeen patients (median age, 24 years; range, 10-52 years) had combined PSPI and 30 patients (median age, 30 years; range, 6-70 years) had isolated PI. Cine magnetic resonance (MR) images (Philips Medical Systems, Best, The Netherlands) in the short-axis plane were used to calculate end-systolic, end-diastolic, and stroke volumes (RVESV, RVEDV, RVSV) and to measure RV wall thickness. Velocity-encoded cine MR images were used to measure pulmonary regurgitation fraction (PRF) by calculating the ratio of backward flow and total forward flow, obtained from the main pulmonary flow analysis. Peak pressure gradient across the pulmonary valve was obtained from spectral Doppler echocardiography. Results: RVEF was 51 AE 8% in the PSPI patients and 39 AE 11%, in the patients with isolated PI (P ¼ 0.001). Additionally, RV wall thickness was 5.2 AE 0.8 mm in the PSPI patients compared to 2.6 AE 0.9 mm in the isolated PI patients (P ¼ 0.001). RVESVi and RVEDVi were significantly lower (P < 0.05) in patients with combined PSPI (60 AE 21 mL/m 2 , 121 AE 35 mL/m 2 , respectively) compared to the patients with isolated PI (95 AE 48 mL/m 2 , 152 AE 61 mL/m 2 , respectively). Conclusion: RV function is preserved in patients with PSPI when compared to patients with PI following surgical repair of TOF.

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“…CMR velocity mapping can also be used to quantify right ventricular diastolic function in the presence of pulmonary regurgitation. Niezen et al used CMR imaging to assess right ventricular diastolic function in young patients with corrected TOF and pulmonary regurgitation [26]. Nineteen children with repair of TOF and 12 healthy children were studied using CMR The authors showed impaired relaxation and restriction to filling affect right ventricular function in children with repair of TOF and pulmonary regurgitation.…”

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confidence: 99%

Diastolic dysfunction: a new additional criterion for optimal timing of pulmonary valve replacement in adult patient with tetralogy of Fallot?

Mulder

Vliegen

Wall

2008

Int J Cardiovasc Imaging

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Biventricular systolic function and mass studied with MR imaging in children with pulmonary regurgitation after repair for tetralogy of Fallot.

Abstract: In children who undergo early surgical repair of tetralogy of Fallot, residual pulmonary regurgitation correlates with biventricular systolic dysfunction and diminished exercise capacity. Despite successful surgical correction, right ventricular hypertrophy may persist.

Cited by 133 publications

References 0 publications

Differential regurgitation in branch pulmonary arteries after repair of tetralogy of fallot: a phase-contrast cine magnetic resonance study

Differential regurgitation in branch pulmonary arteries after repair of tetralogy of fallot: a phase-contrast cine magnetic resonance study

CMR assessment of right ventricular function in patients with combined pulmonary stenosis and insufficiency after correction of tetralogy of Fallot

Diastolic dysfunction: a new additional criterion for optimal timing of pulmonary valve replacement in adult patient with tetralogy of Fallot?

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