Global and regional right ventricular mechanics in repaired tetralogy of Fallot with chronic severe pulmonary regurgitation: a three-dimensional echocardiography study

Abstract

Background Data about the right ventricular (RV) mechanics adaptation to volume overload in patients with repaired tetralogy of Fallot (rToF) are limited. Accordingly, we sought to assess the mechanics of the functional remodeling occurring in the RV of rToF with severe pulmonary regurgitation. Methods We used three-dimensional transthoracic echocardiography (3DTE) to obtain RV data sets from 33 rToF patients and 30 age- and sex- matched controls. A 3D mesh model of the RV was generated, and RV global and regional longitudinal (LS) and circumferential (CS) strain components, and the relative contribution of longitudinal (LEF), radial (REF) and anteroposterior (AEF) wall motion to global RV ejection fraction (RVEF) were computed using the ReVISION method. Results Corresponding to decreased global RVEF (45 ± 6% vs 55 ± 5%, p < 0.0001), rToF patients demonstrated lower absolute values of LEF (17 ± 4 vs 28 ± 4), REF (20 ± 5 vs 25 ± 4) and AEF (17 ± 5 vs 21 ± 4) than controls (p < 0.01). However, only the relative contribution of LEF to global RVEF (0.39 ± 0.09 vs 0.52 ± 0.05, p < 0.0001) was significantly decreased in rToF, whereas the contribution of REF (0.45 ± 0.08 vs 0.46 ± 0.04, p > 0.05) and AEF (0.38 ± 0.09 vs 0.39 ± 0.04, p > 0.05) to global RVEF was similar to controls. Accordingly, rToF patients showed lower 3D RV global LS (-16.94 ± 2.9 vs -23.22 ± 2.9, p < 0.0001) and CS (-19.79 ± 3.3 vs -22.81 ± 3.5, p < 0.01) than controls. However, looking at the regional RV deformation, the 3D CS was lower in rToF than in controls only in the basal RV free-wall segment (p < 0.01). 3D RV LS was reduced in all RV free-wall segments in rToF (p < 0.0001), but similar to controls in the septum (p > 0.05). Conclusions 3DTE allows a quantitative evaluation of the mechanics of global RVEF. In rToF with chronic volume overload, the relative contribution of the longitudinal shortening to global RVEF is affected more than either the radial or the anteroposterior components.

Differential Adaptation of Biventricular Myocardial Kinetic Energy in Patients With Repaired Tetralogy of Fallot Assessed by MR Tissue Phase Mapping

“…Compatible with our results, previous studies on the biventricular function in rTOF patients using strain derived from MRI feature‐tracking 32 or echocardiology 33,34 have shown reduced myocardial longitudinal function. The rTOF group presented a loss of RV KE z and %KE z in both systole and diastole, which may contribute to impairment of the RVEF.…”

Volume Overload Initiates an Immune Response in the Right Ventricle at the Neonatal Stage

“…This in turn has led to a new generation of adolescents who may be prone to the development of heart failure due to residual lesions after correction or palliation of their cardiac defect ( 3 , 4 ). The most prevalent of residual lesions after surgical correction is pulmonary regurgitation after correction for tetralogy of Fallot (TOF), leading to right ventricular (RV) volume overload (VO) ( 5 , 6 ). Long-standing RV VO will induce RV dysfunction, and thus RV VO could serve as a prognostic index in the TOF population ( 7 , 8 ).…”

Echocardiography Imaging of the Right Ventricle: Focus on Three-Dimensional Echocardiography

“…CMR is ideal for accurate quantification of RV volumes and EF; however, 3D echocardiography might help with regular follow-up evaluation and longitudinal RV measurements in this patient population [10]. Furthermore, 3D strain measurements in repaired TOF population revealed that the relative contribution of the longitudinal component to global RVEF was more prominent than either the radial or the anteroposterior shortening [119]. Two-dimensional echocardiography-derived vena contracta diameter, PISA-derived EROA, and 3D-echocardiography-derived vena contracta area can be used to quantify the recently proposed severe, massive, and torrential grades of TR, respectively [12,110,111].…”