Pulmonary Regurgitation Is an Important Determinant of Right Ventricular Contractile Dysfunction in Patients With Surgically Repaired Tetralogy of Fallot

Frigiola, Alessandra; Redington, Andrew N.; Cullen, Seamus; Vogel, Michael

doi:10.1161/01.cir.0000138397.60956.c2

Cited by 203 publications

(157 citation statements)

References 31 publications

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“…Transannular patch reducing right ventricular systolic function after correction of TOF was independent of age at the time of surgery or at the time of the clinical follow-up examination. 22) In this study, low preoperative arterial oxygen saturation was also an independent risk factor for right ventricular systolic dysfunction after correction of TOF. The reason for this may be as follows: on the one hand, the severity of hypoxemia was an important risk factor for ventricular dysfunction in pediatric patients with TOF; 23) on the other hand, lower preoperative arterial oxygen saturation meant more serious obstruction of right ventricular outflow tract obstruction which in turn made it more likely to receive transannular patch.…”

Section: Discussionmentioning

confidence: 51%

Risk Factors for Late Right Ventricular Systolic Dysfunction in Pediatric Patients With Repaired Tetralogy of Fallot

Ji¹,

Mei²,

Wang³

et al. 2015

Int. Heart J.

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SummaryTo evaluate independent risk factors for late right ventricular systolic dysfunction after correction of Tetralogy of Fallot (TOF) in a single-centre, retrospective and observational clinical trial.Patients less than 3 years of age who underwent correction of TOF and subsequently routine clinical follow-up of more than 36 months were included in this study and were divided either into an experimental group (right ventricular systolic dysfunction) or a control group (normal right ventricular systolic function) according to the tricuspid annular peak systolic velocity (TAPSV) value measured by pulsed wave-tissue Doppler imaging (pulsed wave-TDI). The relevant data of all selected patients were investigated and analyzed.From January 2012 to December 2012, a total of 113 consecutive eligible patients were enrolled in this study and were divided either into an experimental group (n = 41) or control group (n = 72). Through univariate analysis and subsequent logistic regression, low preoperative arterial oxygen saturation (OR = 1.66, 95%CI 1.22-4.58, P = 0.0163), age less than 6 months at the time of surgery (OR = 3.45, 95%CI 1.87-9.17, P = 0.0021), and transannular patch (OR = 2.15, 95%CI 1.31-5.38, P = 0.0015) were 3 independent risk factors for late right ventricular systolic dysfunction after correction of TOF.This clinical trial suggested low preoperative arterial oxygen saturation was associated with late right ventricular systolic dysfunction after correction of TOF, and appropriate age at the time of surgery and selection of a proper surgical method to reconstruct the right ventricular outflow tract contributed to improving late right ventricular systolic function in pediatric patients with repaired TOF. (Int Heart J 2015; 56: 80-85)

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Section: Discussionmentioning

confidence: 51%

Risk Factors for Late Right Ventricular Systolic Dysfunction in Pediatric Patients With Repaired Tetralogy of Fallot

Ji¹,

Mei²,

Wang³

et al. 2015

Int. Heart J.

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“…It should be noted that studies which report good long-term outcome for patients following such corrective surgeries focus on the adaptive quality of the RV, in light of the impending PI (16,17). However, this is in direct contraindication to other studies which have demonstrated the deleterious effect of chronic PI on RV function (3)(4)(5)(6). While most patients do well soon after surgical correction, in the setting of hemodynamically significant PI, some will develop RV Fig.…”

Section: Discussionmentioning

confidence: 99%

“…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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“…Advanced echocardiographic assessment of RV function, including measurements of myocardial velocities, strain and strain rate, may provide new insight into RV function under abnormal loading conditions [19,20]. Decreased myocardial velocities and strain rate have been reported in patients after TOF repair compared to normal subjects, not only in the right ventricular free wall but also in the septum and in the left ventricular lateral wall [12,20,21]. This important observation suggests that patients after TOF repair may have decreased intrinsic myocardial contractility, not only of the RV, but also of the left ventricle.…”

Section: Volume Overloadmentioning

confidence: 99%

The right ventricle in tetralogy of Fallot

Stambach¹,

Valsangiacomo²

2009

Schweiz Ärzteztg

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Surgical repair of tetralogy of Fallot (TOF) may be followed by various conditions and residual findings, early postoperatively or late during follow-up. Most of these conditions affect the right ventricular outflow tract and the pulmonary arteries and thus, indirectly, the right ventricle.This paper discusses the role of the right ventricle during the natural history of repaired TOF. The different imaging methods used to assess the function of the right ventricle in relation to this congenital heart disease are highlighted. Particular attention is focused on the volume overloaded right ventricle, as this condition is nowadays a subject of intense discussion, particularly regarding the appropriate timing for pulmonary valve replacement. The most recent literature on this topic is briefly reviewed. In summary, preservation of right ventricular function and prevention of right ventricular arrhythmias are crucial for these patients' survival and outcome. Key words: right ventricle; tetralogy of Fallot; pulmonary regurgitation IntroductionTetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease, occurring in 0.04-0.08% of all liveborns [1, 2]. The main feature of TOF is a ventricular septum defect with anterior deviation of the outlet septum, leading to infundibular subpulmonary stenosis and placing the aorta in an overriding position; in addition, valvular pulmonary stenosis with possible hypoplasia of the main pulmonary artery and its side branches occurs, together with hypertrophy of the right ventricle (RV) ( fig. 1).Besides closing the ventricular septal defect, surgical repair consists of reconstruction of the right ventricular outflow tract (RVOT). RVOT reconstruction can be performed by various surgical techniques, some resulting in residual RVOT obstruction (commissurotomy) and others completely relieving the obstruction at the price of causing pulmonary regurgitation (transannular patch). Thus the surgical technique used usually determines the postoperative findings and eventually the patients' long-term outcome. However, the surgical technique providing the best outcome for the patients has not yet been defined, and the type of repair is chiefly determined by the personal strategy of the operating surgeon in each individual centre. Surgical repair can be performed during the first months of life, ideally at the age of 3 to 4 months, with low perioperative mortality. Long-term mortality was studied by Nollert et al., who reported a 20-year survival rate of 94% [3]. Nevertheless, the survival curve seems to deteriorate after 25 years post TOF repair [3], and significant residual findings may occur resulting in significant morbidity during follow-up. Similarly, Oechslin et al. reported a cumulative percentage of reinterventions required in TOF patients [4]. The most common indications for reintervention consisted of lesions affecting the (RVOT 75%), including severe pulmonary regurgitation, conduit failure and RVOT obstruction. Due to their anatomical location, all these findings may ev...

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Pulmonary Regurgitation Is an Important Determinant of Right Ventricular Contractile Dysfunction in Patients With Surgically Repaired Tetralogy of Fallot

Cited by 203 publications

References 31 publications

Risk Factors for Late Right Ventricular Systolic Dysfunction in Pediatric Patients With Repaired Tetralogy of Fallot

Risk Factors for Late Right Ventricular Systolic Dysfunction in Pediatric Patients With Repaired Tetralogy of Fallot

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

The right ventricle in tetralogy of Fallot

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