Radionuclide assessment of right and left ventricular exercise reserve after total correction of tetralogy of Fallot

Reduto, Lawrence A.; Berger, Harvey J.; Johnstone, David E.; Hellenbrand, William E.; Wackers, Frans J. Th.; Whittemore, Ruth; Cohen, Lawrence S.; Gottschalk, Alexander; Zaret, Barry L.; Pytlik, Linda

doi:10.1016/0002-9149(80)90170-8

Cited by 79 publications

(18 citation statements)

References 27 publications

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“…The utility of radionuclide ventriculography in the assessment of RVEF has been established previously in patients with COPD, pulmonary hypertension, coronary and valvular heart disease [27][28][29]. The reproducibility of the calculated ejection fraction over a wide range is less than three ejection fraction units [23].…”

Section: Discussionmentioning

confidence: 99%

Right ventricular dysfunction in obstructive sleep apnoea: reversal with nasal continuous positive airway pressure

J¹,

Lao²,

Karetzky³

1996

Eur Respir J

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The incidence and pathogenesis of right ventricular dysfunction in obstructive sleep apnoea (OSA) remains controversial. Using nuclear ventriculography, the prevalence of right ventricular dysfunction (RVD) was therefore determined in obese patients with OSA, as well as their clinical characteristics, arterial blood gas values, spirometry and sleep parameters. The reversibility of RVD was evaluated after long-term use of nasal continuous positive airway pressure (nCPAP).We studied 112 obese patients with OSA by nuclear ventriculography, 35 with RVD (Group 1), 77 without RVD (Group 2), and 14 patients without OSA as controls (Group 3). Repeat nuclear ventriculography was performed in seven patients who used nCPAP nightly for 6-24 months.The mean right ventricular ejection fractions (RVEF) were 31%, 47% and 44% in Groups 1, 2 and 3, respectively. Group 1 also had a lower left ventricular ejection fraction (LVEF) of 55 vs 63% in Group 2. The OSA groups did not differ in mean spirometric or arterial blood gas values. Group 1 had a lower mean nocturnal arterial oxygen saturation (Sa,O 2 ) of 82 vs 87% in Group 2, and a longer apnoea duration of 22.3 vs 19.2 s. All but two patients in Group 1 had either awake alveolar hypoventilation or an apnoea + hypopnoea index >40 disordered breathing events·h -1 . Repeat nuclear ventriculography after nCPAP revealed an increase in RVEF from 30 to 39%.In conclusion, right ventricular dysfunction is common in obstructive sleep apnoea, but it is reversible with nasal continuous positive airway pressure treatment and appears to be related to nocturnal oxygen desaturation. Eur Respir J., 1996, 9, 945- [8]. In patients with OSA, left ventricular failure has been demonstrated to exist in the absence of ischaemic or valvular heart disease, and to be reversible with the long-term use of nasal continuous positive airway pressure [9][10][11][12]. Pulmonary hypertension and cor pulmonale have similarly been reported to be associated with OSA [13][14][15][16], but have been attributed to coexisting chronic obstructive pulmonary disease (COPD) [14,15].In a study of 50 patients with OSA, a 12% incidence of right ventricular failure (RVF) was found on the basis of clinical examination and radiological or electrocardiographic criteria [16]. The authors suggested that a "sustained hypoxaemia and/or hypercapnia over a 24 h period" was a necessary prerequisite for the development of RVF in patients with OSA [16]. Another study of 114 OSA patients reported similar relationships between pulmonary hypertension and obstructive lung disease, but 35% of the patients with pulmonary hypertension were not found to have lower airways obstruction [17].To further define and characterize obese patients with OSA who are at increased risk of right (RVD) and left ventricular dysfunction (LVD), we prospectively investigated the sleep parameters, pulmonary function, arterial blood gas values and radionuclide ejection fractions in 126 patients. The effect of long-term treatment utilizing nCPAP on right and ...

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Section: Discussionmentioning

confidence: 99%

Right ventricular dysfunction in obstructive sleep apnoea: reversal with nasal continuous positive airway pressure

J¹,

Lao²,

Karetzky³

1996

Eur Respir J

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“…Previous studies have shown that exercise capacity and hemodynamic responses to exercise in children after the repair of atrial septal defects and tetralogy of Fallot are subnormal [8,12,17,18] . After repair of complex cardiac anomalies there are frequently residual problems which can reduce cardiac function and aerobic capacity .…”

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confidence: 99%

Effects of exercise training on aerobic fitness in children after open heart surgery

et al. 1983

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Graded treadmill tests to maximal exercise were given to 24 children 1 year or more after open-heart surgery and to 26 age- and sex-matched controls, before and after 9 weeks of exercise training to test whether or not they could increase their aerobic fitness levels. The corrected cardiac lesions included tetralogy of Fallot, aortic stenosis, transposition of the great arteries and atrioventricular canal (AVC). Maximal exercise variables measured were heart rate (HR), oxygen consumption (VO2), and workload (stage of exercise and time on treadmill). The results of the pretraining tests indicated that the fitness levels of the 24 patients were significantly less than those of the controls. Of the original groups, 9 controls and 12 patients satisfactorily completed the training (jogging) program. The results of the post-training tests indicated that both the patients and controls significantly improved their fitness levels. Specifically, most subjects improved their maximal workload with little or no increase in maximal HR or VO2. In conclusion, children after open-heart surgery for complex congenital heart disease can further improve their work capacity by a dynamic exercise program. After training, they are able to do more work at a given VO2.

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“…Radionuclide angiography is more useful in the physiologic [1,11,[19][20][21] than anatomic assessment of heart disease in children, although RNA has sufficient anatomic resolution to detect major structural problems [9,15,23,27,29] . Without radiation, cross-sectional echocardiography offers greater anatomic resolution in congenital heart disease than does RNA .…”

Section: Discussionmentioning

confidence: 99%

Radionuclide diagnosis of infradiaphragmatic total anomalous pulmonary venous drainage

et al. 1985

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We hypothesized that infradiaphagmatic total anomalous pulmonary venous drainage (ITAPVD), because of its unique physiology, could be diagnosed with radionuclide angiography. Seven neonates with severe respiratory distress were injected intravenously with 3 mCi technetium-99m pertechnetate. In each of four neonates demonstrated to have ITAPVD by pulmonary angiography, nuclide recirculation through the right atrium occurred 3-6 s after initial passage. In addition, direct visualization of the anomalous common pulmonary trunk with nuclide as a "tail" below the diaphragm was obvious in the third infant studied. This prompted review of the first two infants with ITAPVD; in retrospect the anomalous trunk was also visualized with nuclide in both of these infants. All three were injected via the upper extremity. In the fourth ITAPVD infant, nuclide was injected via the lower extremity. In that infant, preferential streaming of the inferior vena caval flow and nuclide across the foramen ovale into the left heart led to simultaneous opacification of anomalous trunk and descending aorta, obscuring the "tail" sign.

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Radionuclide assessment of right and left ventricular exercise reserve after total correction of tetralogy of Fallot

Cited by 79 publications

References 27 publications

Right ventricular dysfunction in obstructive sleep apnoea: reversal with nasal continuous positive airway pressure

Right ventricular dysfunction in obstructive sleep apnoea: reversal with nasal continuous positive airway pressure

Effects of exercise training on aerobic fitness in children after open heart surgery

Radionuclide diagnosis of infradiaphragmatic total anomalous pulmonary venous drainage

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