Right Ventricular Diastolic Function in Children With Pulmonary Regurgitation After Repair of Tetralogy of Fallot: Volumetric Evaluation by Magnetic Resonance Velocity Mapping

Helbing, Willem A.; Niezen, R A; Cessie, Saskia le; Geest, Rob J. van der; Ottenkamp, Jaap; Roos, Albert de

doi:10.1016/s0735-1097(96)00387-7

Cited by 220 publications

(121 citation statements)

References 23 publications

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“…4 End-systolic and end-diastolic volumes were measured by manually tracing the area of the endocardial surfaces. Ventricular chamber volumes were computed as the sum of LV and RV volumes of all slices containing LV and RV chambers.…”

Section: Mri: Experimental Studies 2 Andmentioning

confidence: 99%

Effects of Pulmonary Insufficiency on Biventricular Function in the Developing Heart of Growing Swine

et al. 2003

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Background-This study was conducted to determine the effects of chronic pulmonary insufficiency (PI) on right (RV) and left (LV) ventricular function in young growing swine. Methods and Results-Six PI and 5 control animals were studied. PI was induced by transcatheter placement of stents across the pulmonary valve. Indices of systolic function (ejection fraction, cardiac output, and cardiac functional reserve), diastolic function (compliance), and myocardial contractility (the slope of the relationship of end-systolic pressure versus end-systolic volume [E max ] and the slope of the dP/dt max -end-diastolic volume relationship [M dP/dt ]) were assessed within 2 days of intervention and 3 months later. MRI was used to quantify PI and ventricular volumes. Conductance catheter techniques were used to obtain indices of contractility and diastolic compliance from pressure-volume relations at rest and under dobutamine infusion. In the PI group, pulmonary regurgitant fraction was 49.2Ϯ5.9% at 3-month follow-up. RV cardiac functional reserve was limited, diastolic function was preserved, and myocardial contractility was altered (E max ϭ2.6Ϯ0.3 mm Hg/mL for the PI group versus 3.5Ϯ0.4 mm Hg/mL for control; PϽ0.01). LV cardiac functional reserve was limited, ventricular compliance decreased, and myocardial contractility was preserved. Conclusions-In the young developing heart, chronic PI alters biventricular systolic function, RV myocardial contractility, and LV diastolic performance.

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Section: Mri: Experimental Studies 2 Andmentioning

confidence: 99%

Effects of Pulmonary Insufficiency on Biventricular Function in the Developing Heart of Growing Swine

et al. 2003

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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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“…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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Right Ventricular Diastolic Function in Children With Pulmonary Regurgitation After Repair of Tetralogy of Fallot: Volumetric Evaluation by Magnetic Resonance Velocity Mapping

Abstract: Impaired relaxation and restriction to filling affect right ventricular function in children with repair of tetralogy of Fallot and pulmonary regurgitation. Restrictive right ventricular physiology is associated with decreased exercise function.

Cited by 220 publications

References 23 publications

Effects of Pulmonary Insufficiency on Biventricular Function in the Developing Heart of Growing Swine

Effects of Pulmonary Insufficiency on Biventricular Function in the Developing Heart of Growing Swine

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

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

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