First report of image integration of cine-angiography with 3D electro-anatomical mapping of the right ventricle in postoperative Tetralogy of Fallot

Abstract Introduction Patients with repaired tetralogy of Fallot (rTF) and severe pulmonary regurgitation frequently progress to dilation and dysfunction of the right ventricle (RV). It has been documented in the literature that there is a correlation between the duration of the QRS in the surface electrocardiogram and the hemodynamic parameters of the RV of these patients, suggesting the presence of a mechanical-electrical interaction. Purpose To determine if there is an association between the contraction delay in certain areas of the RV measured in M-mode echocardiography and the delay in electrical activation measured in the electroanatomic map (EAM) of RV in patients with rTF. Methods Unicentric and observational study of all patients with rTF undergoing EAM, echocardiography with study of RV asynchrony and cardiac magnetic resonance imaging (MRI). Activation delay in the antero-basal area and in the RV outflow tract (RVOT) in the EAM were both analysed (Figure 1A). The shortening delay in the same areas in M-mode echocardiography was also evaluated (Figure 1B, C). MRI data regarding volume and ejection fraction was also collected. Results 64 patients were included (36.7±10.6 years, 65% men). The mean total activation time of the RV (RV-TAT) was 127.3±42.4 ms. Activation mapping showed a recurrent pattern with beginning in the interventricular septum and ending in RV antero-basal region and/or RVOT. A linear positive correlation was observed between RV-TAT and the activation delay in both regions analysed (ρ=0.60 and ρ=0.52, respectively; p<0.001) and also between the electrical and mechanical delay in the anterior wall (ρ=0.41; p=0.001). On the other hand, it was observed a negative correlation between RV ejection fraction (RVEF), measured on MRI, and the RV-TAT (ρ=−0.41, p=0.002) and also between RVEF and the activation delay in the RV antero-basal region and in the RVOT (ρ=−0.32, p=0.016 and ρ=−0.36, p=0.007, respectively). Conclusions There is a mechanical-electrical interaction in the RV of patients with rTF, with a negative correlation between the activation delay and RVEF and between mechanical and electrical activation delay in specific anatomical regions (regional mechanical-electrical interaction). These results may guide future studies on resynchronization in this heart disease. Figure 1. EAM and echocardiographic measures Funding Acknowledgement Type of funding source: None

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TETRALOGI FALLOT DAN ATRESIA PULMONAL

JURNAL BIOMEDIK (JBM) ◽

10.35790/jbm.4.3.2012.1205 ◽

2013 ◽

Vol 4 (3) ◽

Author(s):

Alice I. Supit ◽

Erling D. Kaunang

Keyword(s):

Patent Ductus Arteriosus ◽

Right Ventricle ◽

Tetralogy Of Fallot ◽

Congenital Heart ◽

Heart Diseases ◽

Ductus Arteriosus ◽

Ventricle Hypertrophy ◽

The Right ◽

Right Ventricle Hypertrophy ◽

Patent Ductus

Abstract: Congenital heart disease is a structural defect due to the malformation of the heart, aorta, and or great blood vessels. It is the most frequent congenital malformation in newborn babies. Tetralogy of Fallot is one of the congenital heart diseases (CHD) with central cyanosis, and covers 5-10% of all CHD. We reported a boy of one year old with Tetralogy of Fallot and pulmonal atresia (ToF-PA), associated with bronchopneumonia. The diagnosis was based on anamnesis, physical examination, and other supporting examinations. The chest X-ray showed a normal sized heart (CTR 57%) with coer-en-sabot shape, and right and left parahilar infiltration, which resulted in bronchopneumonia and ToF. The electrocardiography showed a right deviation of axis and a hypertrophy of the right ventricle; the echocardiography showed a right ventricle hypertrophy, an over-riding aorta, a large malalignment of the ventricular septal defect, no visualization of pulmonar artery, and no visualization of patent ductus arteriosus (PDA). Conclusion: Based on all the tests performed, the diagnosis of this patient was Tetralogy of Fallot and pulmonal atresia (ToF-PA), associated with bronchopneumonia. The prognosis related to bronchopneumonia in this case was good due to the use of antibiotics. Keywords: tetralogy of Fallot, pulmona atresia, bronchopneumonia. Abstrak: Penyakit jantung bawaan (PJB) ialah kelainan struktural akibat malformasi jantung, aorta dan atau pembuluh darah besar, dan merupakan kelainan kongenital tersering pada bayi baru lahir. Tetralogi Fallot merupakan salah satu PJB dengan sianosis sentral, dan mencakup 5-10% dari seluruh PJB. Kami melaporkan kasus seorang anak laki-laki berusia satu tahun dengan Tetralogi Fallot dan atresia pulmonal (ToF-PA) disertai bronkopneumonia. Diagnosis ditegakkan melalui anamnesis, pemeriksaan fisik, dan pemeriksaan penunjang. Hasil ekspertisi foto toraks AP memperlihatkan ukuran jantung normal (CTR 57%) berbentuk coer-en-sabot, dan pada paru-paru terlihat infiltrat parahilar kanan dan kiri serta corakan vaskular paru berkurang yang menunjukkan suspek bronkopneumonia dan ToF. Elektrokardiografi memperlihatkan deviasi aksis ke kanan dan hipertrofi ventrikel kanan, dan pada ekokardiografi tampak right ventricle hypertrophy, overriding aorta, VSD malalignment besar, tidak tampak visualisasi arteri pulmonal, dan tidak tampak patent ductus arteriosus (PDA) dengan hasil Tetralogi Fallot dan atresia pulmonal. Simpulan: Berdasarkan hasil pemeriksaan yang dilakukan, diagnosis pasien ini ialah Tetralogi Fallot dan atresia pulmonal (ToF-PA) disertai bronkopneumonia. Prognosis bronkopenumonia pada kasus ini baik yang dapat diatasi dengan antibiotika.Kata kunci: tetralogi Fallot, atresia pulmonal, bronkopneumonia.

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INSTRUMENTAL MARKERS OF THE RIGHT VENTRICLE FUNCTIONAL CONDITION WITH TISSUE DOPPLER IN CHILDREN WITH TETRALOGY OF FALLOT AFTER SURGICAL CORRECTION AND THEIR CONNECTION WITH VALVULAR FUNCTION OF PULMONARY ARTERY

Wiadomości Lekarskie ◽

10.36740/wlek202011108 ◽

2020 ◽

Vol 73 (11) ◽

pp. 2364-2369

Author(s):

Veronika M. Dudnyk ◽

Olha O. Zborovska ◽

Yuilia V. Vyzhga ◽

Vladymyr P. Popov ◽

Valentyn S. Bakhnivskyi

Keyword(s):

Right Ventricle ◽

Tetralogy Of Fallot ◽

Myocardial Dysfunction ◽

Systolic Dysfunction ◽

Pulmonary Regurgitation ◽

Functional Condition ◽

Tissue Doppler ◽

Surgical Correction ◽

Heart Cycle ◽

The Right

The aim: To improve efficacy of the right ventricle functional condition evaluation in children with tetralogy of Fallot after surgical correction by estimation of instrumental markers of myocardial dysfunction. Materials and methods: We completely examined 35 children with tetralogy of Fallot after their surgical correction at the age of 3 – 17 years. For all the patients was presented tissue doppler. We evaluated peak myocardial velocities of right ventrical in different phases of the heart cycle (S, E`, A`), tricuspid annular plane systolic excursion (TAPSE), diastolic myocardial velocities ratio (E/E`), peak myocardial velocity during isovolumic contraction (IVV), isovolumic relaxation time (IVRT). Results: All children of the study group had pulmonary insufficiency of different severity with main predominance of mild pulmonary regurgitation (20 patients, 57,14±8,36 %). Children with tetralogy of Fallot after surgical correction were admitted with: decreased TAPSE up to 1,39±0,28 cm, decreased S` up to 8,00±1,90 cm/s, and decreased IVV up to 5,69±0,95 cm/s that is significantly lower results of the healthy children. Severe pulmonary regurgitation usually followed by high chances of the right ventricle systolic dysfunction, exactly with: decresed TAPSE<1,5 cm (OR=0,500; 95% CI 0,323 – 0,775), S`<8,1 cm/s (OR=0,600; 95% CI 0,420 – 0,858) and IVV<5,9 cm/s (OR=0,250; 95% CI 0,117 – 0,534). As well we admitted significant decline of the velocities in earl and end diastole periods to compare with the results of the control group (E`= 12,11±1,22, A`= 4,56±0,92 cm/s (Р=0,009 and P=0.0002)), boost of the E/E` ratio – 7,96±2,33 (P=0.01) and decline of the RV IVRT up to 43,49±6,04 ms (P=0.017). Severe pulmonary regurgitation followed by high chances of the right ventricle systolic dysfunction development with TAPSE <1,5 cm (OR=0,500; 95% CI 0,323 – 0,775), S`<8,1 cm/s (OR=0,600; 95% CI 0,420 – 0,858) and IVV<5,9 cm/s (OR=0,250; 95% CI 0,117 – 0,534). As well we noticed high chances of the E/E`ratio > 6,0 in 1,5 times (95% CI 1,072 – 1,903) and decreased E` <12,2 cm/s (OR=0,200; 95% CI 0,083 – 0,481). Conclusions: Apart of clinical symptoms of the heart failure in children with tetralogy of Fallot after surgical correction markers of the right ventricle myocardial dysfunction are presented by indices of myocardial velocities, received during tissue doppler in different phases of the heart cycle.

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Haemoptysis in a patient with tetralogy of Fallot: a combined surgical and interventional approach

Cardiology in the Young ◽

10.1017/s1047951103001203 ◽

2003 ◽

Vol 13 (6) ◽

pp. 571-573 ◽

Cited By ~ 1

Author(s):

W. Budts ◽

P. Moons ◽

M. Gewillig

Keyword(s):

Right Ventricle ◽

Tetralogy Of Fallot ◽

Interventional Procedures ◽

Pulmonary Arteries ◽

Pulmonary Haemorrhage ◽

Percutaneous Closure ◽

Collateral Arteries ◽

Interventional Closure ◽

Collateral Artery ◽

The Right

Haemoptysis may occur in patients with tetralogy of Fallot and major aorto-pulmonary collateral arteries. We describe such a patient in whom bleeding from a major aorto-pulmonary collateral artery produced severe pulmonary haemorrhage. Interventional closure of the artery could not be performed because it perfused the native pulmonary arteries. Instead, we inserted a conduit between the right ventricle and the native pulmonary arteries, followed by percutaneous closure of the collateral artery. Our patient demonstrates the increasing necessity for combined surgical and interventional procedures.

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Long-term results after palliative intra-cardiac repair for tetralogy of Fallot and diminutive pulmonary arteries

Cardiology in the Young ◽

10.1017/s1047951119001392 ◽

2019 ◽

Vol 29 (8) ◽

pp. 1036-1039

Author(s):

Yoichi Kawahira ◽

Kyoichi Nishigaki ◽

Koji Kagisaki ◽

Takuji Watanabe ◽

Kazuki Tanimoto

Keyword(s):

Right Ventricle ◽

Tetralogy Of Fallot ◽

Arterial Oxygen Saturation ◽

Pulmonary Arteries ◽

Systolic Pressure ◽

Cardiac Repair ◽

Long Term Results ◽

Arterial Oxygen ◽

The Right

AbstractBackground:In patients with tetralogy of Fallot with the diminutive pulmonary arteries, we sometimes have to give up the complete intra-cardiac repair due to insufficient growth of the pulmonary arteries. We have carried out palliative intra-cardiac repair using a fenestrated patch.Methods:Of all 202 patients with tetralogy of Fallot in our centre since 1996, five patients (2.5%) with the diminutive pulmonary arteries underwent palliative intra-cardiac repair using a fenestrated patch. Mean operative age was 1.8 years. Previous operation was Blalock–Taussig shunt in 4. At operation, the ventricular septal defect was closed using a fenestrated patch and the right ventricular outflow tract was enlarged. Follow-up period was 9.8 ± 2.6 years.Results:There were no operative and late deaths. Fenestration closed spontaneously on its own in four patients 2.7 ± 2.1 years after the intra-cardiac repair with a stable haemodynamics; however, the last patient with the smallest pulmonary artery index had supra-systemic pressure of the right ventricle post-operatively. The fenestration was emergently enlarged. Systemic arterial oxygen saturation was significantly and dramatically increased from 83.5 to 94% after the palliative intra-cardiac repair, and to 98% at the long term. A ratio of systolic pressure of the right ventricle to the left was significantly decreased to 0.76 ± 0.12 at the long term. Now all five patients were Ross classification class I.Conclusion:Although frequent catheter and surgical interventions were needed after the palliative intra-cardiac repair, this repair might be a choice improving quality of life with good results in patients with tetralogy of Fallot associated with the diminutive pulmonary arteries.

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Initial Experience in Chile with Stent Implantation in the Right Ventricle Outflow Tract in High-Risk Patients with Tetralogy of Fallot

Pediatric Cardiology ◽

10.1007/s00246-020-02321-2 ◽

2020 ◽

Vol 41 (4) ◽

pp. 837-842

Author(s):

Paulo Valderrama ◽

Francisco Garay ◽

Daniel Springmüller ◽

Yeny Briones ◽

Daniel Aguirre ◽

...

Keyword(s):

High Risk ◽

Right Ventricle ◽

Tetralogy Of Fallot ◽

Stent Implantation ◽

Outflow Tract ◽

Initial Experience ◽

High Risk Patients ◽

Risk Patients ◽

The Right

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Delayed enhancement imaging in a contemporary patient cohort following correction of tetralogy of Fallot

Cardiology in the Young ◽

10.1017/s1047951114002248 ◽

2014 ◽

Vol 25 (7) ◽

pp. 1268-1275 ◽

Cited By ~ 5

Author(s):

Uta Preim ◽

Philipp Sommer ◽

Janine Hoffmann ◽

Jana Kehrmann ◽

Lukas Lehmkuhl ◽

...

Keyword(s):

Left Ventricle ◽

Right Ventricle ◽

Tetralogy Of Fallot ◽

Nyha Class ◽

Left Ventricular ◽

Delayed Enhancement ◽

Volume Index ◽

Delayed Enhancement Imaging ◽

The Right ◽

Myocardial Scars

AbstractObjectiveTo test the hypothesis that myocardial scars after repair of tetralogy of Fallot are related to impaired cardiac function and adverse clinical outcome.MethodsA total of 53 patients were retrospectively analysed after repair of tetralogy of Fallot. The median patient age was 20 years (range 2–48).Cardiac MRI with a 1.5 T magnet included cine sequences to obtain volumes and function, phase-sensitive inversion recovery delayed enhancement imaging to detect myocardial scars, and flow measurements to determine pulmonary regurgitation fraction. In addition, clinical parameters were obtained.ResultsAn overall 83% of patients were in NYHA class I. All patients with the exception of 2 (96%) had pulmonary insufficiency. Mean ejection fraction and end-diastolic volume index were 46% and 128 ml/m2 for the right ventricle and 54% and 82 ml/m2 for the left ventricle, respectively. Excluding enhancement of the septal insertion and prosthetic patches, delayed enhancement was seen in 11/53 cases (21%). Delayed enhancement of the right ventricle was detected in 6/53 patients (11%) and of the left ventricle in 5/53 patients (9%). The patient group with delayed enhancement was significantly older (p=0.003), had later repair (p=0.007), and higher left ventricular myocardial mass index (p=0.009) compared with the group without delayed enhancement.ConclusionsThis study reveals that scarring is common in patients after surgical repair of tetralogy of Fallot and is associated with older age and late repair. However, there was no difference in right ventricular function, NYHA class, or occurrence of clinically relevant arrhythmias between patients with and those without myocardial scars.

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Biventricular repair of lesions with straddling tricuspid valves using techniques of cordal translocation and realignment

Cardiology in the Young ◽

10.1017/s1047951100009380 ◽

1997 ◽

Vol 7 (2) ◽

pp. 147-152 ◽

Cited By ~ 13

Author(s):

V. Mohan Reddy ◽

John R. Liddicoat ◽

Doff B. McElhinney ◽

Michael M. Brook ◽

Jacques A.M. van Son ◽

...

Keyword(s):

Ventricular Septal Defect ◽

Right Ventricle ◽

Tetralogy Of Fallot ◽

Tricuspid Valve ◽

Septal Defect ◽

Fontan Procedure ◽

Biventricular Repair ◽

The Right ◽

Cardiac Medication ◽

Cavopulmonary Shunt

AbstractSurgical Management of straddling tricuspid valve and associated defects is a complex problem. Between August 1992 and August 1995, 5 patients with major straddling of the tricuspid valve underwent a complete or partial biventricular repair. All patients had either an inlet ventricular septal defect (n=4) or a ventricular septal defect with an inlet component (n=1), Co-existing cardiac lesions included hypoplasia of the right ventricle (n=3), discordant ventriculoarterial connections (n=1), tetralogy of Fallot (n=1), and multiple muscular vetricular septal defects (n=2). At the time of presentation to our institution, two of these patients had previously been palliated in preparation for a Fontan procedure, having undergone construction of a bidirectional superior cavopulmonary shunt. One patient was referred specifically for a Fontan procedure. The tricuspid valve was repaired by transecting all of the straddling cords and reattaching them in the right ventricle or onto the right side of the patch used to close the ventricular septal defect. Associated procedures included closure of the septum in all patients, an arterial switch procedure in one, repair of tetralogy of Fallot in one, and construction of a bidirectional superior cavopulmonary shunt in one. There has been no early or late mortality. Complete heart block requiring insertion of a pacemaker occurred after surgery in three patients. At a median follow-up of 32 months, functional integrity of the tricuspid valve is well maintained, with only one patient having moderate tricuspid regurgitation. None of the patients are receiving any cardiac medication.

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