Outcomes in Young Adults With Tetralogy of Fallot and Pulmonary Annular Preserving or Transannular Patch Repairs

2020 ◽  
Author(s):  
Robin A. Ducas ◽  
Louise Harris ◽  
Christopher Labos ◽  
Govind Krishna Kumar Nair ◽  
Rachel M. Wald ◽  
...  
Keyword(s):  
Young Adults ◽  
Tetralogy Of Fallot ◽  
Transannular Patch ◽  
Patch Repairs

Right ventricular diastolic function after repair of tetralogy of Fallot: its relationship to the insertion of a ‘transannular’ patch

1999 ◽  
Vol 9 (4) ◽  
pp. 384-391 ◽  
Author(s):  
Ayşe Güler Eročlu ◽  
Ayse Sarioşlu ◽  
Tayyar Sariočlu
Keyword(s):  
Right Ventricular ◽  
Diastolic Function ◽  
Tetralogy Of Fallot ◽  
Pulmonary Arteries ◽  
Normal Children ◽  
Forward Flow ◽  
Ventricular Diastolic Function ◽  
Transannular Patch ◽  
Right Ventricular Diastolic Function ◽  
Late Diastole

AbstractExamined was the effect of surgical technique, particularly the insertion of a transannular patch, on right ventricular diastolic function, and the relationship of forward flow in the pulmonary arteries during late diastole to right ventricular diastolic function in patients with tetralogy of Fallot. Transtricuspid, superior caval venous and pulmonary arterial Doppler spectrals were obtained and compared between 44 patients who had been repaired with a transannular patch; 14 patients who had been repaired with muscular resection and/or pulmonary valvotomy; six who had been repaired with an infundubular patch; and 32 normal children. The velocities of forward flow during late diastole in the pulmonary arteries of normal children ranged from 19.8 to 29.4 cm s−1(mean 24.9 ± 2.8 cm s−1) throughout the respiratory cycle. Restrictive right ventricular physiology, defined on the basis of increased forward flow in the pulmonary arteries during late diastole (> 30 cm s−1) was present in 25 (57°) of 44 patients with tetralogy of Fallot repaired using a transannular patch. Right ventricular volume was 50.1 ± 23.7 cm3in patients with a restrictive right ventricle and 64.9 ± 21.4 cm3in patients in whom the ventricle was non-restrictive (p< 0.03). QRS duration was 140 ± 18 and 156 ± 24 ms in patients with restrictive and non-restrictive right ventricular physiology respectively (p< 0.003). Restrictive physiology was not encountered in patients with tetralogy in whom the pulmonary valve had been preserved. It is concluded that right ventricular restriction is present in many patients with tetralogy of Fallot at mid-term follow-up subsequent to repair using a ‘transannular’ patch. Restriction is associated with smaller right ventricular size and less prolongation of the QRS complex.

Abstract 15416: Longitudinal Assessment of Electrical-Mechanical Interactions in Children and Young Adults With Repaired Tetralogy of Fallot

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Suellen M Yin ◽  
Laura M Mercer-rosa ◽  
Jungwon Min ◽  
Elizabeth Goldmuntz ◽  
Victoria L Vetter
Keyword(s):  
Young Adults ◽  
Sudden Cardiac Death ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Cardiac Death ◽  
Volume Ratio ◽  
Rate Of Change ◽  
Ventricular Ectopy ◽  
Repaired Tetralogy Of Fallot ◽  
Over Time

Introduction: Electrical-mechanical interactions contribute to arrhythmias, sudden cardiac death, and right ventricular remodeling in repaired tetralogy of Fallot (TOF). Hypothesis: There are significant changes in electrocardiographic properties and electrical-mechanical interactions that occur over time after complete TOF repair and with pulmonary valve replacement (PVR). Methods: This retrospective cohort study of 177 patients, initially recruited for a cross-sectional research protocol, underwent complete TOF repair at 0.3±0.9 years with 21.5±4.2 years of clinical follow-up. We assessed ECG, Holter, cardiopulmonary exercise testing (CPET), and MRI data. We used linear mixed effects models to examine QRS duration (QRSd) and its rate of change over time, associations between comparable ECG and MRI, Holter and MRI, ECG and Holter, ECG and CPET, and pre-PVR and post-PVR results. Results: QRSd increased after TOF repair, but the rate of change decreased from 5.2 ms/year 1 year post-operatively to 1.7 ms/year 20 years post-operatively. Twenty years from TOF repair, post-operative arrhythmias included ventricular ectopy: ventricular tachycardia (4 of 20 patients) on Holter and premature ventricular contractions (14 of 19 patients) on CPET. QRSd was positively associated with right ventricular (RV) volumes, RV:left ventricular (LV) end-diastolic volume ratio, and complex ventricular ectopy on Holter; and negatively associated with RV ejection fraction (EF). The association between QRSd and RV volumes was weaker post-PVR. QRSd and its rate of change were associated with increased LV volume post-PVR. Complex ventricular ectopy was associated with lower LV EF, and significant atrial ectopy was associated with higher LV mass-to-volume ratio. Conclusions: Substantial ventricular ectopy occurs in adolescents and young adults after repair of TOF. Electrophysiologic changes included QRSd prolongation that progressively slowed. QRSd and its rate of change were associated with published risk factors for arrhythmia and sudden cardiac death, and with indications for PVR. Our ongoing research aims to identify an optimal threshold of pre-PVR QRSd and its rate of change that preserves bi-ventricular electrical-mechanical coupling post-PVR.

Serial assessment of postoperative ventricular mechanics in young children with tetralogy of Fallot: Comparison of transannular patch and valve‐sparing repair

2019 ◽  
Vol 14 (5) ◽  
pp. 691-699
Author(s):  
Vidhya Annavajjhala ◽  
Rajesh Punn ◽  
Theresa A. Tacy ◽  
Frank L. Hanley ◽  
Doff B. McElhinney
Keyword(s):  
Young Children ◽  
Tetralogy Of Fallot ◽  
Ventricular Mechanics ◽  
Transannular Patch ◽  
Valve Sparing

Functional outcome in contemporary children and young adults with tetralogy of Fallot after repair

2018 ◽  
Vol 104 (2) ◽  
pp. 129-133 ◽  
Author(s):  
Julia Hock ◽  
Anna-Luisa Häcker ◽  
Barbara Reiner ◽  
Renate Oberhoffer ◽  
Alfred Hager ◽  
...  
Keyword(s):  
Young Adults ◽  
Arterial Stiffness ◽  
Functional Outcome ◽  
Tetralogy Of Fallot ◽  
Exercise Capacity ◽  
Outcome Measures ◽  
Functional Limitations ◽  
Adolescents And Young Adults ◽  
Z Score ◽  
Recent Cohort

ObjectiveFunctional outcome measures are of growing importance in the aftercare of patients with congenital heart disease. This study addresses the functional status with regard to exercise capacity, health-related physical fitness (HRPF) and arterial stiffness in a recent cohort of children, adolescents and young adults with tetralogy of Fallot (ToF) after repair.DesignSingle-centre, uncontrolled and prospective cohort study.SettingOutpatient department of the German Heart Centre Munich; July 2014–January 2018.PatientsOne hundred and six patients with ToF after repair (13.5±3.7 years, 40 females) were included. Data were compared with a recent cohort of healthy controls (HCs) (n=1700, 12.8±2.6 years, 833 females).Main outcome measuresPatients underwent a symptom-limited cardiopulmonary exercise test, performed an HRPF test (FitnessGram) and had an assessment of their arterial stiffness (Mobil-O-Graph).ResultsCompared with HC, patients with ToF showed lower predicted V.O2 peak (ToF: 80.4% ± 16.8% vs HC: 102.6% ± 18.1%, p<0.001), impaired ventilatory efficiency (ToF: 29.6 ± 3.6 vs HC: 27.4 ± 2.9, p<0.001), chronotropic incompetence (ToF: 167 ± 17 bpm vs HC: 190 ± 17 bpm, p<0.001) and reduced HRPF (ToF z-score: −0.65 ± 0.87 vs HC z-score: 0.03 ± 0.65, p<0.001). Surrogates of arterial stiffness, central and peripheral systolic blood pressure, did not differ between the two groups.ConclusionsContemporary children, adolescents and young adults with ToF still have functional limitations. How impaired HRPF and limited exercise capacity interact and how they can be modified needs to be evaluated in further intervention studies.

scholarly journals A Novel Predictive Value for the Transannular Patch Enlargement in Repair of Tetralogy of Fallot

2016 ◽  
Vol 101 (2) ◽  
pp. 703-707 ◽  
Author(s):  
Kwang Ho Choi ◽  
Si Chan Sung ◽  
Hyungtae Kim ◽  
Hyung Doo Lee ◽  
Gil Ho Ban ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Predictive Value ◽  
Transannular Patch

scholarly journals Outcomes of prenatally diagnosed tetralogy of Fallot: Implications for valve-sparing repair versus transannular patch

2010 ◽  
Vol 26 (1) ◽  
pp. e1-e6 ◽  
Author(s):  
Alim Hirji ◽  
Alessandra Bernasconi ◽  
Brian W. McCrindle ◽  
Elizabeth Dunn ◽  
Rebecca Gurofsky ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Transannular Patch ◽  
Valve Sparing

scholarly journals Pulmonary valve restitution following transannular patch repair of tetralogy of Fallot†

2017 ◽  
Vol 25 (6) ◽  
pp. 985-986 ◽  
Author(s):  
Khushboo N Parikh ◽  
Nishant C Shah ◽  
Joseph B Clark ◽  
John L Myers
Keyword(s):  
Tetralogy Of Fallot ◽  
Pulmonary Valve ◽  
Patch Repair ◽  
Transannular Patch
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