Right ventricular overload and induced sustained ventricular tachycardia in operatively “repaired” tetralogy of Fallot

Marié, Pierre; Marçon, F; Brunotte, François; Briançon, Serge; Danchin, Nicolás; Worms, A M; Robert, Jacques; Pernot, C

doi:10.1016/0002-9149(92)90506-t

Cited by 128 publications

(54 citation statements)

References 29 publications

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“…Slow conduction within an anatomic isthmus was suggested in 10 of our 11 patients by a prolonged S-QRS during pace mapping or entrainment. 14 RV remodeling induced by pressure or volume load might promote hypertrophy and fibrosis with slow conduction, providing the link between impaired hemodynamics and VT. 25,26 However, in our series, only 2 patients had undergone a second operation for pulmonary regurgitation and 2 had moderate regurgitation. RV incision and myectomy produce RVOT aneurysmal or akinetic regions in Ͼ50% of the patients.…”

Section: Previous Studiesmentioning

confidence: 58%

Catheter Ablation of Ventricular Tachycardia After Repair of Congenital Heart Disease

et al. 2007

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Background— Catheter ablation of ventricular tachycardia (VT) after repair of congenital heart disease can be difficult because of nonmappable VTs and complex anatomy. Insights into the relation between anatomic isthmuses identified by delineating unexcitable tissue using substrate mapping techniques and critical reentry circuit isthmuses might facilitate ablation. Methods and Results— Sinus rhythm voltage mapping of the right ventricle was performed in 11 patients with sustained VT after repair of congenital heart disease. Unexcitable tissue from patch material, valve annulus, or dense fibrosis, identified from bipolar voltage (<0.5 mV) and pacing threshold (>10 mA), was defined as an anatomic isthmus boundary bordering 4 isthmuses between (1) the tricuspid annulus and scar/patch in the anterior right ventricular outflow, (2) the pulmonary annulus and right ventricular free wall scar/patch, (3) the pulmonary annulus and septal scar/patch, and (4) the septal scar/patch and tricuspid annulus. The reentry circuit isthmuses of all induced 15 VTs (mean cycle length, 276±78 ms; 73% poorly tolerated), identified by activation, entrainment, and/or pace mapping, were located in an anatomic isthmus (11 of 15 VTs in anatomic isthmus 1). Transecting the anatomic isthmuses by ablation lesions abolished all VTs. During 30.4±29.3 months of follow-up, 91% of patients remained free of VT. Conclusions— Reentry circuit isthmuses in VT late after repair of congenital heart disease are located within anatomically defined isthmuses bordered by unexcitable tissue. The boundaries can be identified with 3-dimensional substrate mapping and connected by ablation lines during sinus rhythm. These findings should facilitate catheter and surgical ablation of stable and unstable VTs.

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Section: Previous Studiesmentioning

confidence: 58%

Catheter Ablation of Ventricular Tachycardia After Repair of Congenital Heart Disease

et al. 2007

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“…Previous studies have shown that the clinically important arrhythmias are associated with older age at repair, 4,8,10,[12][13][14][15] large ventriculotomy, 10 high postoperative right ventricular pressure, 8,10,[12][13][14] tricuspid and/or pulmonary regurgitation, 2,12,15-17 cardiomegaly 2,18 or long QRS duration. 2,3,18 We therefore included these parameters in the data file for the analysis of risk factors.…”

Section: Subjectsmentioning

confidence: 99%

Arrhythmias Late After Repair of Tetralogy of Fallot-A Japanese Multicenter Study-

Nakazawa

Shinohara

Sasaki

et al. 2004

Circ J

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“…Although satisfactory results have been obtained by surgery performed in the neonatal period and infancy together with the use of TAP with well-tolerated free pulmonary insufficiency [8][9][10][11][12], some studies have demonstrated that free pulmonary insufficiency induced by the TAP procedure is not well tolerated; and RV dysfunction [13][14], low functional status [15], arrhythmia, and sudden death [16][17] have been reported in the long-term follow-up of these patients. Gatzoulis et al reported that occurrence of free pulmonary insufficiency after TAP repair was associated with ventricular tachycardia and sudden death in the long-term follow-up period [17].…”

Section: Discussionmentioning

confidence: 99%

Congenital heart disease in children and adults Comparison of the Mid-term Results of Pulmonary Valve-sparing Strategy and Transannular Patch Repair in Tetralogy of Fallot

Arslan¹,

Adademir²,

Elibol³

et al. 2013

kitp

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StreszczenieWprowadzenie: Pomiędzy styczniem 2006 roku a październi-kiem 2009 roku 148 pacjentów zostało poddanych całkowitej korekcji tetralogii Fallota (TOF). U 13 pacjentów przed całkowitą korekcją przeprowadzono zabiegi paliatywne, natomiast u pozostałych 135 pacjentów całkowita korekcja była pierwszym i definitywnym zabiegiem. Materiał i metody: Pacjenci po zabiegu całkowitej korekcji tetralogii Fallota zostali poddani retrospektywnej ewaluacji. Przypisano ich do jednej z dwóch grup, w zależności od tego, czy zastosowano u nich łatę przezpierścieniową (transannular patch -TAP), czy strategie oszczędzające zastawkę pnia płucnego (pulmonary valve-sparing -PVS). Grupy porównano w zakresie wieku, wagi, płci, struktury pierścieni, śródoperacyjnego stosunku ciśnienia prawej komory do ciśnienia lewej komory (RV/LV) oraz resztkowego gradientu skurczowego RVOT, rozkurczowej grubości ściany prawej komory w osi przymostkowej długiej, związanej z wiekiem dylatacji, śmiertelności i zachorowalności w czasie obserwacji. Wyniki: Liczba pacjentów z (zależną od wieku) rozkurczową dylatacją prawej komory była znacząco większa w grupie TAP (88,9%) niż w grupie PVS (4,8%; p = 0,0009). Średnio odległe wyniki stosowania strategii oszczędzającej zastawkę pnia płuc-nego były znacząco lepsze od wyników stosowania łat przezpierścieniowych w zakresie ochrony funkcji prawej komory. Wnioski: Aby chronić funkcję zastawki pnia płucnego, należy w miarę możliwości unikać korekcji TAP. Strategia oszczędzająca zastawkę pnia płucnego wydaje się skutkować mniejszą około-operacyjną i odległą zachorowalnością oraz zapewniać lepszą długoterminową ochronę funkcji prawej komory w porównaniu z korekcją TAP. Słowa kluczowe: tetralogia Fallota, przezpierścieniowy. CONGENITAL HEART DISEASE IN CHILDREN AND ADULTS AbstractBackground: Between January 2006 and October 2009, 148 patients underwent total repair of tetralogy of Fallot (TOF). In 13 patients, palliative procedures were performed before total repair, while total correction was the initial and definitive procedure in 135 patients. Materials and methods: Patients who underwent total repair of TOF were evaluated retrospectively. They were assigned to one of two groups based on the right ventricular outflow tract (RVOT) reconstruction technique used: the transannular patch (TAP) group or the pulmonary valve-sparing strategy group. The two groups were compared with regard to age, weight, gender, annular structure, intraoperative right ventricular to left ventricular (RV/LV) pressure ratio, residual RVOT systolic gradient, RV diastolic parasternal long axis wall thickness, agespecific dilation, mortality, and morbidity during follow-up. Results: The percentage of patients with RV diastolic dilation (age specific) was significantly higher in the TAP group (88.9%) than in the pulmonary valve-sparing group (4.8%; p = 0.0009). The mid-term results of the pulmonary valve-sparing strategy were significantly superior to TAP repair in terms of preservation of right ventricular function. Conclusion: In order to...

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Right ventricular overload and induced sustained ventricular tachycardia in operatively “repaired” tetralogy of Fallot

Cited by 128 publications

References 29 publications

Catheter Ablation of Ventricular Tachycardia After Repair of Congenital Heart Disease

Catheter Ablation of Ventricular Tachycardia After Repair of Congenital Heart Disease

Arrhythmias Late After Repair of Tetralogy of Fallot-A Japanese Multicenter Study-

Congenital heart disease in children and adults Comparison of the Mid-term Results of Pulmonary Valve-sparing Strategy and Transannular Patch Repair in Tetralogy of Fallot

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Right ventricular overload and induced sustained ventricular tachycardia in operatively “repaired” tetralogy of Fallot

Cited by 128 publications

References 29 publications

Catheter Ablation of Ventricular Tachycardia After Repair of Congenital Heart Disease

Catheter Ablation of Ventricular Tachycardia After Repair of Congenital Heart Disease

Arrhythmias Late After Repair of Tetralogy of Fallot-A Japanese Multicenter Study-

﻿﻿Congenital heart disease in children and adults Comparison of the Mid-term Results of Pulmonary Valve-sparing Strategy and Transannular Patch Repair in Tetralogy of Fallot

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Congenital heart disease in children and adults Comparison of the Mid-term Results of Pulmonary Valve-sparing Strategy and Transannular Patch Repair in Tetralogy of Fallot