Right ventricular outflow tract obstruction as a confounding factor in the assessment of the impact of pulmonary regurgitation on the right ventricular size and function in patients after repair of tetralogy of fallot

AbstractThere is ongoing debate regarding the initial management of symptomatic neonates with tetralogy of Fallot. Although neonatal repair can be performed with low mortality, it is associated with increased morbidity and long-term impact on right ventricular performance. Traditionally, the modified Blalock–Taussig shunt remains the palliative procedure of choice. Differential pulmonary artery flow may occur and subsequently result in underdevelopment and distortion of pulmonary vessels. Transcatheter therapy was previously limited to balloon valvulotomy when the obstruction is predominantly at the pulmonary valve level. Stenting of the right ventricular outflow tract can enable adequate forward flow; however, pulmonary regurgitation may impact on right ventricular performance and cardiac output. Stenting of the right ventricular outflow tract with valve sparing placement of the stent thus treating the underlying pathophysiology of the hypercyanotic spells provides a safe and effective management strategy, improving arterial oxygen saturation, avoiding pulmonary regurgitation and encouraging pulmonary artery growth.

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NORMAL VALUES FOR RIGHT VENTRICULAR SIZE AND FUNCTION USING THE RIGHT VENTRICLE-FOCUSED VIEW ON ECHOCARDIOGRAPHY

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)02744-3 ◽

2021 ◽

Vol 77 (18) ◽

pp. 1386

Author(s):

Ravi Masson ◽

Neil Mehta ◽

Priya Mehta ◽

Monvadi Srichai-Parsia

Keyword(s):

Right Ventricle ◽

Right Ventricular ◽

Normal Values ◽

Ventricular Size ◽

Right Ventricular Size ◽

The Right ◽

And Function

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The Impact of the Right Ventricular Outflow Tract Patch on Right Ventricular Strain in Tetralogy of Fallot: A Comparison with Valvar Pulmonary Stenosis Utilizing Cardiac Magnetic Resonance

Pediatric Cardiology ◽

10.1007/s00246-016-1558-5 ◽

2017 ◽

Vol 38 (3) ◽

pp. 617-623 ◽

Cited By ~ 6

Author(s):

Shafkat Anwar ◽

Matthew A. Harris ◽

Kevin K. Whitehead ◽

Marc S. Keller ◽

Elizabeth Goldmuntz ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Right Ventricular ◽

Pulmonary Stenosis ◽

Right Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Right Ventricular Strain ◽

The Right ◽

The Impact ◽

Valvar Pulmonary Stenosis

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P210 The influence of the right ventricle on the right atrium: a speckle tracking echocardiography study

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.078 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

M Zehnpfennig ◽

C Braun ◽

K Kupczynska ◽

J D Kasprzak ◽

B Michalski ◽

...

Keyword(s):

Right Ventricle ◽

Right Ventricular ◽

Speckle Tracking ◽

Longitudinal Strain ◽

Right Atrial ◽

Ventricular Size ◽

Right Ventricular Size ◽

Deformation Parameters ◽

The Right ◽

And Function

Abstract Purpose To investigate the relationship between right atrial deformation and the right ventricular size and function. Methods 94 patients with various cardiovascular pathologies have been included in the study group. All patients underwent transthoracic echocardiography with subsequent off-line analysis using speckle tracking technique and measurement of numerous right atrial deformation parameters, including peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS), as well as established indices of right ventricular size and function, including right ventricular basal diameter in apical four-chamber view (RVITd), tricuspid annular peak systolic excursion (TAPSE) and global longitudinal strain (GLS). Results There was a statistically significant weak correlation between RA strain (PACS and PALS) and RV parameters. RV-GLS showed significant correlation with PALS (r = -0,38; p = 0,0015) and PACS (r = - 0,30; p = 0,013). Similarly, TAPSE correlated with PALS and PACS (r = 0,34; p = 0,02) and (r = 0,23; p = 0,04) respectively. However, there was no correlation between right atrial function and RVIT. Conclusions Right atrial deformation parameters weakly correlate with right ventricular function indices and show no correlation with the size of the right ventricle.

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Recent advances in transcatheter management of pulmonary regurgitation after surgical repair of tetralogy of Fallot

F1000Research ◽

10.12688/f1000research.14301.1 ◽

2018 ◽

Vol 7 ◽

pp. 679 ◽

Cited By ~ 4

Author(s):

Matthew I Jones ◽

Shakeel A Qureshi

Keyword(s):

Right Ventricular ◽

Tetralogy Of Fallot ◽

Surgical Repair ◽

Pulmonary Regurgitation ◽

Right Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Outflow Tract ◽

Repeat Surgery ◽

Patch Technique ◽

The Right

Surgical repair of tetralogy of Fallot (ToF) in childhood is associated with generally good outcomes, and almost all children can be expected to survive until adulthood. However, significant pulmonary regurgitation leading to progressive right ventricular dilatation is common in teenagers or young adults because of the nature of the surgical intervention. In patients whose repair included placement of a right ventricle to pulmonary artery conduit, it has been possible to place a stented valve within the conduit to treat this. Pulmonary regurgitation after repair of ToF via a transannular patch technique has historically involved repeat surgery as the dimensions of the right ventricular outflow tract have been too large for commercially available valves. This review summarises the novel transcatheter valves available for management of pulmonary regurgitation after surgical repair of ToF in patients in whom the dimensions of the right ventricular outflow tract have previously been considered too large for transcatheter valve implantation.

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