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Journal of Cardiovascular Magnetic Resonance, 2011
Background: Diastolic dysfunction of the right ventricle (RV) is common after repair of tetralogy of Fallot. While restrictive physiology in late diastole has been well known, dysfunction in early diastole has not been described. The present study sought to assess the prevalence and mechanism of early diastolic dysfunction of the RV defined as delayed onset of the tricuspid valve (TV) flow after TOF repair. Methods: The study population consisted of 31 children with repaired TOF (mean age ± SD, 12.3 ± 4.1 years) who underwent postoperative cardiovascular magnetic resonance (CMR). The CMR protocol included simultaneous phase-contrast velocity mapping of the atrioventricular valves, which enabled direct comparison of the timing and patterns of tricuspid (TV) and mitral (MV) valve flow. The TV flow was defined to have delayed onset when its onset was > 20 ms later than the onset of the MV flow. The TV and MV flow from 14 normal children was used for comparison. The CMR results were correlated with the findings on echocardiography and electrocardiography. Result: Delayed onset of the TV flow was observed in 16/31 patients and in none of the controls. The mean delay time was 64.81 ± 27.07 ms (8.7 ± 3.2% of R-R interval). The delay time correlated with the differences in duration of the TV and MV flow (55.94 ± 32.88 ms) (r = 0.90, p < 0.001). Delayed onset was associated with prolongation of the RV ejection time in 9 and delayed onset and cessation of the pulmonary arterial flow in 4. Delayed onset was not associated with timing changes in the pulmonary artery in 3. The patients with delayed onset showed reduced RV ejection fraction (p = 0.01). However, the two groups did not show significant differences in TV E/A ratio, ventricular end-diastolic volumes, left ventricular ejection fraction, pulmonary regurgitant fraction, heart rate, PR interval and QRS duration.
The International Journal of Cardiovascular Imaging, 2016
Abbreviations CMR Cardiac magnetic resonance LV Left ventricle LVEDVi Left ventricle end-diastolic volume indexed LVESVi Left ventricle end-systolic volume indexed PRF Pulmonary regurgitation fraction RV Right ventricle RVEF Right ventricle ejection fraction RVEDVi Right ventricle end-diastolic volume indexed RVESVi Right ventricle end-systolic indexed RVSP Right ventricle systolic pressure RVOT Right ventricle outflow tract TOF Tetralogy of Fallot
Echocardiographic findings before and after surgical repair of Tetralogy of Fallot
JPMA. The Journal of the Pakistan Medical Association, 2015
To compare echocardiographic findings before and after surgical repair of Tetralogy of Fallot. The interventional study was conducted in Ali-ebne-Abitaleb Hospital, Zahedan, Iran, from September 2008 to March 2010, and comprised patients undergoing surgical repair of Tetralogy of Fallot. Physical examination, chest radiography and electrocardiography were done before echocardiography. Data were analysed by using SPSS 20. Of the 30 patients, 10(33.3%) were girls and 20(66.6%) boys, with an overall pre-surgery mean age of 47.40±21.34 months and 74.46±20.63 months post-surgery (p=0.001). The mean duration of post-operative period was 37.86±18.27 months. The results for right heart showed that Z scores for peak E velocity, peak A velocity, pre-ejection period, isovolumic relaxation time, myocardial performance index and isovolumic contraction time were significantly different (p<0.05). In the left heart, aortic, left atrium, left ventricular end-systolic dimension, left ventricular e...
Hemodynamic evaluation of 221 patients after intracardiac repair of tetralogy of Fallot
The American Journal of Cardiology, 1974
Cardiac catheterization and angiocardiographic studies were performed in 221 patients an average of 2 years (range 2 weeks to 10 years) after intracardiac repair of tetralogy of Fallot. The group represented 32.5 percent of the postoperative survivors. The postoperative result was classified as "excellent" (43 percent), "good" (35 percent), "satisfactory" (7 percent) or "unsatisfactory" (14 percent) on the basis of right ventricular peak systolic pressure, right ventricle to pulmonary artery peak systolic gradient and presence of a persistent large or small left to right shunt at the ventricular level. Unsatisfactory results were associated with obstructive pulmonary vascular disease (four patients), severe malformations with obstruction of the right ventricular outflow tract and/or a left to right shunt with a Qp:Qs ratio of greater than 1.51 or with currently uncorrectable obstructive anomalies of the right ventricular outflow tract or pulmonary arteries.
The Israel Medical Association journal : IMAJ, 2007
Surgical repair of tetralogy of Fallot may leave the patient with pulmonary regurgitation, causing eventual right ventricle dilatation and dysfunction. Predicting clinical deterioration may help to determine the best timing for intervention. To assess whether the clinical and humoral status of patients in the second decade after repair of ToF is worse than that of patients in the first decade after repair. Twenty-one patients with repaired ToF underwent clinical assessment, electrocardiogram, echocardiogram and measurement of plasma B-type natriuretic peptide and N-terminal pro-BNP as well as the 6 minute walk distance test. Patients were divided into two groups: group A - less than 10 years after repair (n=10, age < 12 years old), and group B - more than 10 years after repair (n=11, age > 12 years old). The age at repair was similar in both groups. In all but one patient the distance in the 6 min walk test was less than the minimum for age. RV end-diastolic volume and the 6 m...
The journal of Tehran Heart Center, 2012
Longer survival after the total repair of the Tetralogy of Fallot increases the importance of late complications such as right ventricular dysfunction. This is a prospective study of the right ventricular function in totally corrected Tetralogy of Fallot patients versus healthy children. Thirty-two healthy children were prospectively compared with 30 totally corrected Tetralogy of Fallot patients. Right ventricular myocardial tissue velocities, right ventricular myocardial performance index, and tricuspid annular plane systolic excursion were investigated as well as the presence and severity of pulmonary regurgitation. The two groups were age-and sex-matched. Mean systolic peak velocity (Sa) and tricuspid annular plane systolic excursion were significantly decreased, while myocardial performance index and early to late diastolic velocity (Ea/Aa) were significantly increased in the Tetralogy of Fallot patients. Early diastolic velocity (Ea) showed no significant difference between th...
Right Ventricular Diastolic Function After Repair of Tetralogy of Fallot
Pediatric Cardiology, 2006
The objective of this study was quantitate diastolic dysfunction in the postoperative phase of tetralogy of Fallot (TOF) and to correlate it with the type of surgical procedure and clinical parameters. Fifty consecutive patients (mean age, 5.0 years; mean weight, 13.5 kg), operated for TOF during the period November 2004 to May 2005, were prospectively studied [infundibular resection, 23; infundibular resection and transannular patch (TAP), 19; right ventricle fi pulmonary artery conduit, 8). Detailed echocardiography was done on postoperative days 3 and 9 with a focus on Doppler indices of right ventricular (RV) function, Antegrade late diastolic flow in the right ventricular outflow tract (RVOT) was taken as the marker of restrictive RV physiology. The previous parameters were correlated to the type of surgery and clinical indices of RV dysfunction. There was no mortality. Twenty-four patients showed restrictive RV physiology. This finding correlated with lower values of E/A ratio (0.98 ± 0.17 vs 1.33 ± 0.49, p < 0.002), tricuspid valve E-wave deceleration time (86.9 ± 21.7 vs 151.4 ± 152 msec, p < 0.05), index of myocardial performance (0.15 ± 0.06 vs 0.26 ± 0.09, p < 0.001), isovolumic relaxation time (19.4 ± 17 vs 39±30 msec, p < 0.009), and a higher central venous pressure (15.1 ± 1.5 vs 12.7 ± 1.9, p < 0.001). Restrictive RV physiology correlated with prolonged intensive case unit (ICU) stay (5.1 ± 3.7 vs 2.8 ± 2 days, p < 0.015), longer duration of inotropic support (108.3 ± 56.2 vs 55.5 ± 28.3 hours, p < 0.02), and higher dosage of diuretics. RV diastolic dysfunction is demonstrable by Doppler echocardiography in the first week following surgery for TOF and tends to be worse with TAP. Restrictive physiology demonstrated by RVOT pulse Doppler predicts longer duration of inotropic support, prolonged ICU stay, and higher dosage of diuretics.
Current pediatric reviews, 2015
The surgical treatment of tetralogy of Fallot can be considered as a success story in the history of congenital heart diseases. Since the early outcome is no longer the main issue, the focus moved to the late sequelae of TOF repair, i.e. the pulmonary insufficiency and the secondary adaptation of the right ventricle. This review provides recent insights into the pathophysiological alterations of the right ventricle in relation to the reconstruction of the right ventricular outflow tract after repair of tetralogy of Fallot. Its clinical relevance is documented by addressing the policy changes regarding the optimal management at the time of surgical repair as well as properly defining criteria and timing for late pulmonary valve implantation.