Flow Energy Loss as a Predictive Parameter for Right Ventricular Deterioration Caused by Pulmonary Regurgitation After Tetralogy of Fallot Repair

AbstractBackground:Severe pulmonary regurgitation may result in right ventricular volume overload and decreased right ventricular function. Severe pulmonary regurgitation can be predicted prior to repair of tetralogy of Fallot. The aim of this study was to determine the risk factors for severe pulmonary regurgitation in repaired tetralogy of Fallot with transannular patch.Methods:This was a cross-sectional study in 43 patients with repaired tetralogy of Fallot using transannular patch. This study was carried out in Dr. Cipto Mangunkusumo hospital during 2015 to 2018. Participants were followed up for routine examination using echocardiography. We used bivariate and multivariate logistic regression using STATA 12.1 to identify risk factors for severe pulmonary regurgitation in this population.Results:A total of 43 patients composed of 22 boys and 21 girls with repaired tetralogy of Fallot using transannular patch were enrolled in the study. Median age of participants was 6 years at admission (2.1–18.5 years) and 3.4 years (1–17 years) at repair. Median length of follow-up was 2.1(1–4.3) years. Risk factors associated with severe pulmonary regurgitation after tetralogy of Fallot repair were McGoon ratio > 1.8 (odds ratio = 6.9; 95% confidence interval = 1.6–30) and follow-up duration >1.9 years (odds ratio = 3.6; 95% confidence interval = 0.9–15.2).Conclusion:McGoon ratio > 1.8 and follow-up duration > 1.9 years are associated with severe pulmonary regurgitation after tetralogy of Fallot repair.

Download Full-text

Vicious circle between progressive right ventricular dilatation and pulmonary regurgitation in patients after tetralogy of Fallot repair? Right heart enlargement promotes flow reversal in the left pulmonary artery

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/s12968-016-0254-1 ◽

2016 ◽

Vol 18 (1) ◽

Cited By ~ 9

Author(s):

Atsuko Kato ◽

Christian Drolet ◽

Shi-Joon Yoo ◽

Andrew N. Redington ◽

Lars Grosse-Wortmann

Keyword(s):

Pulmonary Artery ◽

Right Ventricular ◽

Tetralogy Of Fallot ◽

Pulmonary Regurgitation ◽

Left Pulmonary Artery ◽

Flow Reversal ◽

Vicious Circle ◽

Right Heart ◽

Right Ventricular Dilatation ◽

Tetralogy Of Fallot Repair

Download Full-text

High Variability of Right Ventricular Volumes and Function in Adults with Severe Pulmonary Regurgitation Late After Tetralogy of Fallot Repair

The American Journal of Cardiology ◽

10.1016/j.amjcard.2021.11.022 ◽

2021 ◽

Author(s):

Matthias Greutmann ◽

Javier Ruperti ◽

Fabienne Schwitz ◽

Nora Haag ◽

Bruno Santos Lopes ◽

...

Keyword(s):

Right Ventricular ◽

Tetralogy Of Fallot ◽

Pulmonary Regurgitation ◽

High Variability ◽

Ventricular Volumes ◽

And Function ◽

Tetralogy Of Fallot Repair

Download Full-text

P1495Energy loss by right ventricular pacing: normal left ventricular function vs. hypertrophic cardiomyopathy

European Heart Journal ◽

10.1093/eurheartj/ehz748.0259 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

Y Arakawa ◽

H Fukaya ◽

R Kakizaki ◽

J Oikawa ◽

G Matsuura ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Energy Loss ◽

Right Ventricular ◽

Left Ventricular ◽

Lv Function ◽

Outflow Obstruction ◽

Flow Energy ◽

Rv Pacing ◽

Flow Energy Loss ◽

The Impact

Abstract Background Right ventricular (RV) pacing causes left ventricular (LV) dysfunction. On the other hand, RV pacing for hypertrophic obstructive cardiomyopathy (HOCM) is an established treatment. LV flow energy loss (EL) is a new hemodynamic index for assessing cardiac function. However, the impact of RV pacing on EL remains unknown. Objective The objective of this study was to investigate the EL by RV pacing on normal LV function and hypertrophic cardiomyopathy (HCM). Methods A total of 28 patients underwent echocardiography for EL assessment under AAI (without RV pacing) and DDD (with all RV pacing) mode. Among them, 16 were sick sinus syndrome (SSS) patients with normal LV function, and 12 were HCM patients. EL was calculated from color Doppler images using a vector flow mapping. Results There were no significant difference in patients' background parameters between the SSS and the HCM groups. In the SSS group, mean systolic EL was significantly increased from AAI to DDD mode (14.9 to 19.2 mW/m, P<0.01, Panel A), whereas diastolic EL was not changed from AAI to DDD mode (22.3 to 18.8 mW/m, P=0.12). In the HCM group, systolic mean EL was significantly decreased from AAI to DDD mode (29.9 to 22.5 mW/m, P<0.01, Panel B) irrespectively of with or without LV outflow obstruction, whereas diastolic mean EL was not changed from AAI to DDD mode (28.6 to 24.3 mW/m, P=0.47). Change of flow energy loss Conclusion RV pacing increased mean systolic EL in normal LV function, but decreased in HCM with or without LV outflow obstruction. In the patients with HCM, the impact of RV pacing on EL is different compared with normal LV function.

Download Full-text

Moving beyond size: vorticity and energy loss are correlated with right ventricular dysfunction and exercise intolerance in repaired Tetralogy of Fallot

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/s12968-021-00789-2 ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Yue-Hin Loke ◽

Francesco Capuano ◽

Vincent Cleveland ◽

Jason G. Mandell ◽

Elias Balaras ◽

...

Keyword(s):

Energy Loss ◽

Right Ventricular ◽

Tetralogy Of Fallot ◽

Stress Test ◽

Pulmonary Regurgitation ◽

Exercise Stress ◽

Exercise Intolerance ◽

Contrast Imaging ◽

4D Flow ◽

Repaired Tetralogy Of Fallot

Abstract Background The global effect of chronic pulmonary regurgitation (PR) on right ventricular (RV) dilation and dysfunction in repaired Tetralogy of Fallot (rTOF) patients is well studied by cardiovascular magnetic resonance (CMR). However, the links between PR in the RV outflow tract (RVOT), RV dysfunction and exercise intolerance are not clarified by conventional measurements. Not all patients with RV dilation share the same intracardiac flow characteristics, now measurable by time resolved three-dimensional phase contrast imaging (4D flow). In our study, we quantified regional vorticity and energy loss in rTOF patients and correlated these parameters with RV dysfunction and exercise capacity. Methods rTOF patients with 4D flow datasets were retrospectively analyzed, including those with transannular/infundibular repair and conduit repair. Normal controls and RV dilation patients with atrial-level shunts (Qp:Qs > 1.2:1) were included for comparison. 4D flow was post-processed using IT Flow (Cardioflow, Japan). Systolic/diastolic vorticity (ω, 1/s) and viscous energy loss (VEL, mW) in the RVOT and RV inflow were measured. To characterize the relative influence of diastolic vorticity in the two regions, an RV Diastolic Vorticity Quotient (ωRVOT-Diastole/ωRV Inflow-Diastole, RV-DVQ) was calculated. Additionally, RVOT Vorticity Quotient (ωRVOT-Diastole/ωRVOT-Systole, RVOT-VQ) and RVOT Energy Quotient (VELRVOT-Diastole/VELRVOT-Systole, RVOT-EQ) was calculated. In rTOF, measurements were correlated against conventional CMR and exercise stress test results. Results 58 rTOF patients, 28 RV dilation patients and 12 controls were included. RV-DVQ, RVOT-VQ, and RVOT-EQ were highest in rTOF patients with severe PR compared to rTOF patients with non-severe PR, RV dilation and controls (p < 0.001). RV-DVQ positively correlated with RV end-diastolic volume (0.683, p < 0.001), PR fraction (0.774, p < 0.001) and negatively with RV ejection fraction (− 0.521, p = 0.003). Both RVOT-VQ, RVOT-EQ negatively correlated with VO2-max (− 0.587, p = 0.008 and − 0.617, p = 0.005) and % predicted VO2-max (− 0.678, p = 0.016 and − 0.690, p = 0.001). Conclusions In rTOF patients, vorticity and energy loss dominate the RVOT compared to tricuspid inflow, correlating with RV dysfunction and exercise intolerance. These 4D flow-based measurements may be sensitive biomarkers to guide surgical management of rTOF patients.

Download Full-text