Pulmonary regurgitation in the late postoperative follow-up of tetralogy of Fallot. Volumetric quantitation by nuclear magnetic resonance velocity mapping.

Rebergen, Sidney A.; Chin, J. G. J.; Ottenkamp, Jaap; Wall, Ernst E. van der; Roos, Albert de

doi:10.1161/01.cir.88.5.2257

Cited by 266 publications

(127 citation statements)

References 31 publications

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“…Flow Quantification.-VEC MR imaging has been shown to be an accurate method for the noninvasive quantification of blood flow (28 that protons in motion change phase angle in proportion to velocity, VEC MR imaging makes use of a bipolar gradient to phase encode the velocity of flow. The technique creates two imaging sets: one by subtracting the signal intensity created by stationary spins from that created by moving spins (phase image), and the other by combining the signal intensities created by stationary and moving spins (magnitude image).…”

Section: Vec Mr Imagingmentioning

confidence: 99%

Cardiovascular MR Imaging after Surgical Correction of Tetralogy of Fallot: Approach Based on Understanding of Surgical Procedures

Ordovás¹,

Muzzarelli²,

Hope³

et al. 2013

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Section: Vec Mr Imagingmentioning

confidence: 99%

Cardiovascular MR Imaging after Surgical Correction of Tetralogy of Fallot: Approach Based on Understanding of Surgical Procedures

Ordovás¹,

Muzzarelli²,

Hope³

et al. 2013

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“…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.…”

mentioning

confidence: 99%

“…Previous studies have validated the utility and accuracy of PC MR in evaluation of pulmonary regurgitation at the main pulmonary artery level, and it is now used as a routine clinical tool in such patients. 8,9 We recently recognized, during clinical PC MR studies, that pulmonary valve regurgitation may be associated with markedly different patterns of regurgitation in the branch pulmonary arteries. This experience prompted us to formally assess these flow patterns in the branch pulmonary arteries in all patients undergoing magnetic resonance (MR) for evaluation of the pulmonary arterial anatomy and flow distribution in the lungs after surgical repair of TOF.…”

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confidence: 99%

Differential Regurgitation in Branch Pulmonary Arteries After Repair of Tetralogy of Fallot

et al. 2003

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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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“…Continuous exposure to pulmonary regurgitation leads to progressive RV dilation and dysfunction, therefore initiating adverse clinical outcomes (arrhythmias, heart failure, sudden cardiac death) [7,40,41]. PR is consistent with transannular patch use in TOF patients, a technique predominantly applied in the 20th century to relieve RVOT obstruction [42]. Optimal timing for late pulmonary valve replacement (PVR) after surgical TOF is crucial and needs to be chosen wisely.…”

Section: Residual Pulmonary Regurgitation and Right Ventricular Dilationmentioning

confidence: 81%

Late arrhythmia in patients with repaired tetralogy of Fallot: who is at risk?

Grigaliūnas

Gumbienė

Valevičienė

et al. 2015

Seminars in Cardiovascular Medicine

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SummaryTetralogy of Fallot (TOF) is the most common cause of cyanotic congenital heart defect. Over the last century, the life expectancy of TOF patients has significantly improved. This, however, has brought new challenges both to patients and their health-care providers, the main of them being late arrhythmia. Ironically, late arrhythmia is predominantly generated due to the fibrotic scars caused by the life-saving surgical repair. Once the first two mainly arrhythmia-free decades after the repair pass, the risk of developing late arrhythmia and, therefore, SCD becomes substantial. Consequently, young adults with repaired Tetralogy of Fallot (rTOF) require careful outpatient monitoring.There have been many attempts to predict the risk of life-threatening arrhythmia in rTOF patients. This has led to the defining of various risk factors, ranging from the widely used QRS prolongation to novel predictors, derived from cardiac magnetic resonance (CMR) based anatomical findings (left ventricular dyssynchrony indexes, right ventricular output tract akinetic length, right ventricular mass-to-volume ratio). The latter predictors have recently established CMR as a tool of high significance in evaluation of rTOF patients.Although the role of Holter monitoring findings in rTOF patient-assessment remains unclear, it may be useful in those who are 25 years and older. Implantable cardioverter-defibrillator (ICD) implantation is the first-line treatment for secondary prevention of sudden cardiac death (SCD). rTOF patients suffer from the highest rate of inappropriate and the lowest rate of appropriate ICD shocks, when compared to other congenital heart diseases. As a consequence, ICD implantation for primary SCD prevention should be carefully weighed. Catheter-based ablation therapy leads to high rate of initial success when abolishing monomorphic ventricular tachycardia and intra-atrial reentrant tachycardia, however recurrence rates remain high. Seminars in Cardiovascular Medicine

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Pulmonary regurgitation in the late postoperative follow-up of tetralogy of Fallot. Volumetric quantitation by nuclear magnetic resonance velocity mapping.

Abstract: NMR velocity mapping is an accurate method for the noninvasive, volumetric quantification of pulmonary regurgitation after surgical correction of tetralogy of Fallot.

Cited by 266 publications

References 31 publications

Cardiovascular MR Imaging after Surgical Correction of Tetralogy of Fallot: Approach Based on Understanding of Surgical Procedures

Cardiovascular MR Imaging after Surgical Correction of Tetralogy of Fallot: Approach Based on Understanding of Surgical Procedures

Differential Regurgitation in Branch Pulmonary Arteries After Repair of Tetralogy of Fallot

Late arrhythmia in patients with repaired tetralogy of Fallot: who is at risk?

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