Repaired tetralogy of Fallot with coexisting unrepaired partial anomalous pulmonary venous connection is associated with diminished right ventricular ejection fraction and more severe right ventricular dilation

AbstractObjectiveThe role of right ventricular longitudinal strain for assessing patients with repaired tetralogy of Fallot is not fully understood. In this study, we aimed to evaluate its relation with other structural and functional parameters in these patients.MethodsPatients followed-up in a grown-up CHD unit, assessed by transthoracic echocardiography, cardiac MRI, and treadmill exercise testing, were retrospectively evaluated. Right ventricular size and function and pulmonary regurgitation severity were assessed by echocardiography and MRI. Right ventricular longitudinal strain was evaluated in the four-chamber view using the standard semiautomatic method.ResultsIn total, 42 patients were included (61% male, 32±8 years). The mean right ventricular longitudinal strain was −16.2±3.7%, and the right ventricular ejection fraction, measured by MRI, was 42.9±7.2%. Longitudinal strain showed linear correlation with tricuspid annular systolic excursion (r=−0.40) and right ventricular ejection fraction (r=−0.45) (all p<0.05), which in turn showed linear correlation with right ventricular fractional area change (r=0.50), pulmonary regurgitation colour length (r=0.35), right ventricular end-systolic volume (r=−0.60), and left ventricular ejection fraction (r=0.36) (all p<0.05). Longitudinal strain (β=−0.72, 95% confidence interval −1.41, −0.15) and left ventricular ejection fraction (β=0.39, 95% confidence interval 0.11, 0.67) were independently associated with right ventricular ejection fraction. The best threshold of longitudinal strain for predicting a right ventricular ejection fraction of <40% was −17.0%.ConclusionsRight ventricular longitudinal strain is a powerful method for evaluating patients with tetralogy of Fallot. It correlated with echocardiographic right ventricular function parameters and was independently associated with right ventricular ejection fraction derived by MRI.

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Evaluation of ventricular function and myocardial deformation in children with repaired tetralogy of Fallot by real-time three-dimensional (four-dimensional) echocardiography

Cardiology in the Young ◽

10.1017/s1047951121005126 ◽

2022 ◽

pp. 1-9

Author(s):

Ayşe G. Eroğlu ◽

Selman Gökalp ◽

Sezen U. Atik ◽

Damla Önal ◽

Hazal C. Acar ◽

...

Keyword(s):

Ejection Fraction ◽

Right Ventricular ◽

Tetralogy Of Fallot ◽

Radial Strain ◽

Left Ventricular ◽

Ventricular Ejection ◽

Myocardial Deformation ◽

Ventricular Ejection Fraction ◽

Ventricular Volumes ◽

Repaired Tetralogy Of Fallot

Abstract Aim: The left and right ventricular dysfunction are important clinical course indicators in patients with repaired tetralogy of Fallot. This study aimed to evaluate ventricular volumes, functions, and myocardial deformation in children with repaired tetralogy of Fallot by real-time three-dimensional (four-dimensional) echocardiography and compared with healthy children. It also aimed to investigate the relationships between ventricular volumes, functions, and myocardial deformation parameters in the patients. Materials and methods: In this cross-sectional study, 35 patients (mean age 15.1 ± 2.8 years, 54% male) and 35 healthy controls of similar age, gender, and body measurements underwent echocardiography. End-diastolic volume index, end-systolic volume index, and ejection fractions of both ventricles; global longitudinal, circumferential, radial strain, twist, and torsion of the left ventricle; the longitudinal strain of the right ventricle free wall and septum were measured. Results: Left ventricular ejection fraction, global circumferential and radial strain, twist and torsion were significantly lower in patients compared with controls. Left ventricular ejection fraction correlated with global circumferential (r = −0.446, p < 0.001) and radial strain (r = −0.433, p < 0.001) in the patients. Right ventricular volumes were significantly higher, and ejection fraction was significantly lower in patients compared with controls. All right ventricular parameters correlated with each other in the patients. Conclusion: Left ventricular contraction pattern was changed, circumferential and radial fibres were most affected in the patients. Right ventricular dilatation and dysfunction were detected, and right ventricular ejection fraction correlated well with strain measurements of the right ventricle.

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Tricuspid annular plane systolic excursion and right ventricular ejection fraction in pediatric and adolescent patients with tetralogy of Fallot, patients with atrial septal defect, and age-matched normal subjects

Clinical Research in Cardiology ◽

10.1007/s00392-010-0213-z ◽

2010 ◽

Vol 100 (1) ◽

pp. 67-75 ◽

Cited By ~ 41

Author(s):

Martin Koestenberger ◽

Bert Nagel ◽

William Ravekes ◽

Allen D. Everett ◽

Hans Peter Stueger ◽

...

Keyword(s):

Ejection Fraction ◽

Right Ventricular ◽

Atrial Septal Defect ◽

Tetralogy Of Fallot ◽

Septal Defect ◽

Right Ventricular Ejection Fraction ◽

Normal Subjects ◽

Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Adolescent Patients

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Evaluation of tricuspid annular plane systolic excursion measured with cardiac MRI in children with tetralogy of Fallot

Cardiology in the Young ◽

10.1017/s1047951115001456 ◽

2015 ◽

Vol 26 (4) ◽

pp. 718-724 ◽

Cited By ~ 4

Author(s):

Jonathan H. Soslow ◽

Emem Usoro ◽

Li Wang ◽

David A. Parra

Keyword(s):

Ejection Fraction ◽

Right Ventricular ◽

Ventricular Function ◽

Tetralogy Of Fallot ◽

Right Ventricular Function ◽

Cardiac Mri ◽

Right Ventricular Ejection Fraction ◽

Ventricular Ejection Fraction ◽

Repaired Tetralogy Of Fallot ◽

Z Scores

AbstractBackgroundAneurysmal dilation of the right ventricular outflow tract complicates assessment of right ventricular function in patients with repaired tetralogy of Fallot. Tricuspid annular plane systolic excursion is commonly used to estimate ejection fraction. We hypothesised that tricuspid annular plane systolic excursion measured by cardiac MRI approximates global and segmental right ventricular function, specifically right ventricular sinus ejection fraction, in children with repaired tetralogy of Fallot.MethodsTricuspid annular plane systolic excursion was measured retrospectively on cardiac MRIs in 54 patients with repaired tetralogy of Fallot. Values were compared with right ventricular global, sinus, and infundibular ejection fractions. Tricuspid annular plane systolic excursion was indexed to body surface area, converted into a fractional value, and converted into published paediatric Z-scores.ResultsTricuspid annular plane systolic excursion measurements had good agreement between observers. Right ventricular ejection fraction did not correlate with the absolute or indexed tricuspid annular plane systolic excursion and correlated weakly with fractional tricuspid annular plane systolic excursion (r=0.41 and p=0.002). Segmental right ventricular function did not appreciably improve correlation with any of the tricuspid annular plane systolic excursion measures. Paediatric Z-scores were unable to differentiate patients with normal and abnormal right ventricular function.ConclusionsTricuspid annular plane systolic excursion measured by cardiac MRI correlates poorly with global and segmental right ventricular ejection fraction in children with repaired tetralogy of Fallot. Tricuspid annular plane systolic excursion is an unreliable approximation of right ventricular function in this patient population.

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