Effect of Pulmonary Artery Stenoses on the Cardiopulmonary Response to Exercise Following Repair of Tetralogy of Fallot

Influence of Pulmonary Regurgitation Inequality on Differential Perfusion of the Lungs in Tetralogy of Fallot After Repair

“…Phase-contrast flow measurement has been integrated in comprehensive cardiopulmonary MRI in evaluation of TOF (6,10). From In TOF after repair, it is important to know the differential lung perfusion, because asymmetry of lung perfusion is one of the predictors of outcome and exercise capacity (11)(12)(13)(14). Although the impact of pulmonary regurgitation on right ventricular dysfunction has been extensively investigated, its impact on lung perfusion has not been explored yet.…”

“…Because peripheral pulmonary stenosis, especially over LPA, might occur in approximately 20% of patients with TOF after repair (14), the effect of peripheral pulmonary stenosis on accuracy of PC-MRI requires investigation. Recent study has confirmed that PC-MRI is feasible for differential lung perfusion in patients with suspected unilateral pulmonary stenosis (9).…”

“…Clinical impact. Precise estimation of pulmonary perfusion has gained an increasingly important role in comprehensive evaluation of cardiopulmonary function in TOF after repair (11)(12)(13)(14). Because peripheral pulmonary stenosis occurs not uncommonly over the LPA in repaired TOF, underestimation of differential perfusion of the left lung by conventional PC-MRI method with NFV ratio, as illustrated in Figure 1, would lead to an overestimation of LPA stenosis; as a result, unnecessary invasive procedures such as catheterization and balloon vascular dilatation might be conducted.…”

Ductus-associated proximal pulmonary artery stenosis in patients with right heart obstruction

“…The implications for the subset of these patients progressing toward single-ventricle palliation are clear-in several analyses of outcome variables for Fontan patients, pulmonary hypoplasia has been associated with poor outcome, including takedown of Fontan and death [14,15]. Additionally, pulmonary artery hypoplasia in patients with twoventricle repair has been associated with decreased cardiopulmonary response to exercise [16] and increased surgical mortality [17].…”

Timing and type of surgery for severe pulmonary regurgitation after repair of tetralogy of Fallot

“…Many investigators have shown a clear relationship between severity of residual PR and decreased exercise capacity, maximal oxygen uptake and ventilatory anaerobic threshold [26]. Associated lesions, especially branch pulmonary artery stenosis further compromise exercise capacity [32]. A decrease in PR and an abnormal RV response to exercise in patients with rTOF has also been described [33].…”