Left and Right Ventricular Impairment Shortly After Correction of Tetralogy of Fallot

Terol, Covadonga; Kamphuis, Vivian P.; Hazekamp, Mark G.; Blom, Nico A.; Harkel, Arend D J Ten

doi:10.1007/s00246-020-02355-6

Cited by 6 publications

(7 citation statements)

References 34 publications

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“…These findings are in agreement with previous studies describing temporarily decreased ventricular performance following ToF repair. 21 22 Biventricular GLS following PVR did not differ statistically significantly across study time points. TDI TV S′—another parameter of RV function—did follow a pattern of temporarily impaired ventricular function.…”

Section: Discussionmentioning

confidence: 79%

Ventricular function and biomarkers in relation to repair and pulmonary valve replacement for tetralogy of Fallot

et al. 2023

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ObjectiveCardiac surgery may cause temporarily impaired ventricular performance and myocardial injury. We aim to characterise the response to perioperative injury for patients undergoing repair or pulmonary valve replacement (PVR) for tetralogy of Fallot (ToF).MethodsWe enrolled children undergoing ToF repair or PVR from four tertiary centres in a prospective observational study. Assessment—including blood sampling and speckle tracking echocardiography—occurred before surgery (T1), at the first follow-up (T2) and 1 year after the procedures (T3). Ninety-two serum biomarkers were expressed as principal components to reduce multiple statistical testing. RNA Sequencing was performed on right ventricular (RV) outflow tract samples.ResultsWe included 45 patients with ToF repair aged 4.3 (3.4 – 6.5) months and 16 patients with PVR aged 10.4 (7.8 – 12.7) years. Ventricular function following ToF repair showed a fall-and-rise pattern for left ventricular global longitudinal strain (GLS) (−18±4 to −13±4 to −20±2, p < 0.001 for each comparison) and RV GLS (−19±5 to −14±4 to 20±4, p < 0.002 for each comparison). This pattern was not seen for patients undergoing PVR. Serum biomarkers were expressed as three principal components. These phenotypes are related to: (1) surgery type, (2) uncorrected ToF and (3) early postoperative status. Principal component 3 scores were increased at T2. This increase was higher for ToF repair than PVR. The transcriptomes of RV outflow tract tissue are related to patients’ sex, rather than ToF-related phenotypes in a subset of the study population.ConclusionsThe response to perioperative injury following ToF repair and PVR is characterised by specific functional and immunological responses. However, we did not identify factors relating to (dis)advantageous recovery from perioperative injury.Trial registration numberNetherlands Trial Register: NL5129.

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Section: Discussionmentioning

confidence: 79%

Ventricular function and biomarkers in relation to repair and pulmonary valve replacement for tetralogy of Fallot

et al. 2023

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“…Weidemann et al report has shown abnormal function in regional biventricular systolic myocardial function in asymptomatic repaired TOF children that are related to irregular electrical depolarization in the right ventricle 23 . Furthermore, a recent study in the assessment of biventricular function utilizing tissue Doppler imaging and speckle tracking has shown a significant decrease in left interventricular septum strain shortly after TOF surgery, but not in the fractional shortening 21 . Although ventricular strain worsens early after surgical repair, DiLorenzo et al have demonstrated that strain recovers through two postoperative years but long‐term ventricular dysfunction may begin early after surgery 24 …”

Section: Discussionmentioning

confidence: 97%

“…This utilizing tissue Doppler imaging and speckle tracking has shown a significant decrease in left interventricular septum strain shortly after TOF surgery, but not in the fractional shortening. 21 Although ventricular strain worsens early after surgical repair, DiLorenzo et al have demonstrated that strain recovers through two postoperative years but long-term ventricular dysfunction may begin early after surgery. 24 Our findings revealed a significant correlation between left ventricular strain and aortic cross-lamp time and cardiopulmonary bypass.…”

Section: Discussionmentioning

confidence: 99%

Biventricular strain and strain rate impairment shortly after surgical repair of tetralogy of Fallot in children: A case‐control study

Dehghan

Ahmadi

Moghadam

et al. 2022

Health Science Reports

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Background: Early biventricular dysfunction in repaired tetralogy of Fallot (TOF) children may lead to poor clinical outcomes. We aimed to assess biventricular function in TOF children before and after surgery by speckle tracking echocardiography (STE) and compare them with the controls.Methods: Twenty repaired TOF children and 20 normal children as controls were assessed by STE. Tricuspid annular plane systolic excursion (TAPSE), left ventricular ejection fraction (LVEF), biventricular strain, and strain rate were compared before and after surgery and between TOF children and controls.Results: Postoperative LVEF (p = 0.001), strain (p = 0.001), and strain rate (p = 0.001) for left ventricle improved significantly compared to preoperative phase. However, postoperative left ventricular strain (p = 0.05) and strain rate (p = 0.01) in TOF children were significantly impaired compared to controls. Postoperative LVEF was correlated inversely with postoperative strain rate (r = −0.40, p = 0.04). Postoperative TAPSE (p = 0.001), strain (p = 0.001), and strain rate (p = 0.001) for right ventricle significantly worsened when compared with the preoperative phase. Moreover, postoperative TAPSE (p = 0.001), strain (p = 0.001), and strain rate (p = 0.01) were significantly impaired compared to controls. Postoperative right ventricular strain rate was correlated significantly with the weight of children (r = 0.48, p = 0.02), and postoperative left ventricular strain showed significant correlations with aortic clamp time (r = 0.44, p = 0.04) and with ICU stay (r = −0.46, p = 0.04). Conclusion:Despite normal LVEF, TOF children exhibit impaired left ventricular strain and strain rate after surgery. TAPSE, strain, and strain rate for the right ventricle worsen after surgical repair. STE-driven strain can be used to detect early ventricular dysfunction and the associated prognostic implications.

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“…Previous studies have shown varying degrees of histopathological changes and mild fibrosis in muscle specimens from TOF patients ( 11 , 18 ). Some studies found the function of both the left and right ventricles to be damaged ( 19 ), which is also believed to be related to myocardial fibrosis ( 20 ). Notably, TP repair can lead to pulmonary regurgitation (PR), inducing RV volume overload and often progressive RV dilation, which may include the development of tricuspid regurgitation and RV dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Adverse events after repair of tetralogy of Fallot: prediction models by machine learning of a retrospective cohort study in western China

Xi¹,

Xiang²,

Wu³

et al. 2023

Transl Pediatr

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Background The incidence of clinical adverse events after tetralogy of Fallot (TOF) repair remains high. This study was performed to explore risk factors for adverse events and develop a prediction model through machine learning (ML) to forecast the incidence of clinical adverse events after TOF repair. Methods A total of 281 participants who were treated with cardiopulmonary bypass (CPB) at our hospital from January 2002 to January 2022 were included in the study. Risk factors for adverse events were explored by composite and comprehensive analyses. Five artificial intelligence (AI) models were used for ML to build prediction models and screen out the model with the best performance in predicting adverse events. Results CPB time, differential pressure of the right ventricular outflow tract (RVOTDP or DP), and transannular patch repair were identified as the main risk factors for adverse events. The reference point for CPB time was 116.5 minutes and that for right ventricular (RV) outflow tract differential pressure was 70 mmHg. SPO 2 was a protective factor, with a reference point of 88%. By integrating the results for the training and validation cohorts, we confirmed that, among all models, the logistic regression (LR) model and Gaussian Naive Bayes (GNB) model were stable, showing good discrimination, calibration and clinical practicability. The dynamic nomogram can be used as a predictive tool for clinical application. Conclusions Differential pressure of the RV outflow tract, CPB time, and transannular patch repair are risk factors, and SPO 2 is a protective factor for adverse events after complete TOF repair. In this study, models developed by ML were established to predict the incidence of adverse events.

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Left and Right Ventricular Impairment Shortly After Correction of Tetralogy of Fallot

Cited by 6 publications

References 34 publications

Ventricular function and biomarkers in relation to repair and pulmonary valve replacement for tetralogy of Fallot

Ventricular function and biomarkers in relation to repair and pulmonary valve replacement for tetralogy of Fallot

Biventricular strain and strain rate impairment shortly after surgical repair of tetralogy of Fallot in children: A case‐control study

Adverse events after repair of tetralogy of Fallot: prediction models by machine learning of a retrospective cohort study in western China

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