Severe pulmonary regurgitation in adolescents with tetralogy of Fallot leads to increased longitudinal strain

Abstract

Objectives Postoperative patients with tetralogy of Fallot (TOF) are often compromised by chronic pulmonary regurgitation and chronic right ventricular volume load. We sought to determine whether pulmonary regurgitation (PR) would affect right and left ventricle (RV and LV) strain. Materials and methods This cross-sectional analysis included 40 patients who had TOF with surgical repair, with an average follow-up period of 11.8 ± 3.0 years. Altogether, 44 healthy volunteers with similar age and gender distribution were recruited. A cardiovascular magnetic resonance imaging study with feature tracking analysis was performed on all patients and controls. Results RV peak longitudinal strain was increased in TOF patients with PR > 30 ml/m 2 when compared to those with PR < 30 ml/m 2 (− 22.5% ± 2.7% vs − 19.7% ± 3.5%, p = 0.018) and controls (p = 0.007). PR volume correlated with peak RV longitudinal strain (R = − 0.37, p = 0.030) and peak RV longitudinal strain rate (systolic: R = 0.37, p = 0.03; diastolic: R = 0.39, p = 0.021). The peak RV circumferential strain, from base to apex, increased more than in healthy controls (apexbase difference 7.6% ± 4.2% vs 3.3% ± 2.4%, p < 0.0001). Conclusions Pediatric patients with TOF and a severe pulmonary regurgitation show an enhanced longitudinal strain when compared to patients with milder regurgitation or to control subjects. In addition, mean RV circumferential strain of the patients is significantly enhanced compared to healthy individuals.

Right-left ventricular shape variations in tetralogy of Fallot: associations with pulmonary regurgitation

“…Our study also found a relationship between RV longitudinal shortening and the amount of regurgitation, in agreement with Ylitalo et al [ 18 ]. However, conclusions regarding the effects of PR on longitudinal shortening have varied between studies.…”

“…However, conclusions regarding the effects of PR on longitudinal shortening have varied between studies. In pediatric populations, Ylitalo et al [ 18 ] found the PR led to an increase in RV LS, on the other hand, Eyskens et al . [ 58 ] and Ouyang et al .…”

Assessing right ventricular systolic function using ultrasonic speckle‐tracking imaging in repaired Tetralogy of Fallot with different pulmonary artery branch angles

“…However, there was no significant difference between the groups with different degrees of pulmonary regurgitation, which agrees with our findings. In patients with TOF, the longitudinal strain was elevated for severe pulmonary regurgitation (vs mild or absent regurgitation) and may be related to the compensatory capacity of the right ventricular wall after surgery, which may suggest that myocardial motion resulted in transient enhancement with relief of right ventricular outflow obstruction 18 …”