P3467Tricuspid annular isovolumic acceleration is more useful for the assessment of right ventricular systolic function in patients after repair of tetralogy of Fallot with pulmonary regurgitation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Toyono ◽  
S Yamada ◽  
M Aoki-Okazaki ◽  
T Takahashi
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Systolic Function ◽  
Pulmonary Regurgitation ◽  
Flow Reversal ◽  
Myocardial Velocity ◽  
Diastolic Flow ◽  
Isovolumic Contraction ◽  
Detrimental Impact ◽  
Rv Function

Abstract Introduction The detrimental impact of pulmonary regurgitation (PR) on right ventricular (RV) function of patients after repair of tetralogy of Fallot (TOF) is recognized. Although tricuspid annular isovolumic acceleration (IVA) is useful for the evaluation of RV function, it requires complicated measurement. Tricuspid annular plane systolic excursion (TAPSE) is measured easily and has also been validated as a marker of RV systolic function. Hypothesis We assessed the hypothesis that IVA has advantage to the stratification of the detrimental impact of PR on RV systolic function after TOF repair compared with TAPSE. Methods We prospectively examined patients after TOF repair. Patients <1 year after the repair, those with the history of sustained arrhythmia and those who required concomitant tricuspid and/or pulmonary valve surgery were excluded from the study. IVA was measured by dividing the myocardial velocity during isovolumic contraction by the time interval from the onset of the myocardial velocity during the isovolumic contraction to the time at the peak velocity of this wave. TAPSE was measured using M-mode echocardiography with the M-line passing through the lateral annulus of tricuspid valve in the apical 4-chamber plane. PR jets were evaluated in the parasternal short-axis plane. PR degree was assessed by the number of correspondence to the following conditions; 1) diastolic flow reversal in the main pulmonary artery, 2) diastolic flow reversal in the branch pulmonary arteries, 3) pressure half-time of PR signal <100 msec and 4) the ratio of the duration of the PR signal to the total duration of diastole <0.77. PR degree was graded from 0 to 4. Results Twenty-two patients were enrolled to the study. Age, female, period after the TOF repair and body height of the patients were 11±6 years, 55%, 9±5 years and 137±28 cm, respectively. In all the patients, IVA and TAPSE were 160±27 cm/sec2 and 12±2 mm, respectively. PR degrees were graded as 2, 3 and 4 in 4, 14 and 4 patients, respectively. By the Kruskal-Wallis test, only IVA showed a significant difference among the 3 PR degrees. Conclusion In conclusion, IVA can be a useful index for the stratification of RV function in patients after TOF repair with various degrees of PR.

scholarly journals Multi-plane echocardiographic assessment of right ventricular function in adults with repaired Tetralogy of Fallot

2021 ◽  
Author(s):  
Daniel J. Bowen ◽  
An M. van Berendoncks ◽  
Jackie S. McGhie ◽  
Jolien W. Roos-Hesselink ◽  
Annemien E. van den Bosch
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Systolic Function ◽  
Peak Systolic Velocity ◽  
Control Group ◽  
Imaging Method ◽  
Repaired Tetralogy Of Fallot ◽  
Detailed Assessment ◽  
Echocardiographic Assessment ◽  
Rv Function

AbstractIn patients with repaired Tetralogy of Fallot (ToF), detailed assessment of right ventricular (RV) function is important for management and timing of possible pulmonary valve re-intervention. The aim of this study was to evaluate RV function using two-dimensional multi-plane echocardiography (2D MPE), a novel four-wall imaging method obtained from one apical acoustic window utilising electronic plane rotation. In sixty-two ToF patients (aged - 28 [22, 39] years, 65% male), systolic function of four different RV walls (lateral, anterior, inferior and inferior coronal) were evaluated using MPE. Tricuspid annular plane systolic excursion (TAPSE), tricuspid annular peak systolic velocity (RV-S′) and RV wall longitudinal strain (RV-LS) measurements were compared with those of matched healthy individuals. 2D MPE measurements were highly feasible across the four RV walls (93.5–100% for TAPSE/S′; 66.1–95.1% for RVLS) and could be performed more reliably than 3D RV ejection fraction (RVEF − 56.5%). All functional values were significantly reduced when compared to the control group (p < 0.001). Higher RV-LS values were seen in the lateral (− 17.8 ± 4.5%) and inferior (− 17.8 ± 4.2%) walls compared to the anterior (− 15.9 ± 3.8%) and inferior coronal (− 15.1 ± 3.9%) walls. 3D RVEF correlated strongest with RV-LS values from the lateral (r − 0.50; p = 0.002) and anterior walls (r − 0.74; p < 0.001) and furthermore the four-wall average (r − 0.57; p = 0.001). 2D MPE evaluation of the RV is highly feasible in ToF patients. This novel method provides new insights into regional RV wall function, enabling a more comprehensive and quantitative approach to RV assessment in daily clinical practice.

scholarly journals Multi-plane echocardiographic assessment of right ventricular function in adults with repaired Tetralogy of Fallot

2021 ◽  
Author(s):  
Daniel Bowen ◽  
An van Berendoncks ◽  
Jackie McGhie ◽  
Jolien Roos-Hesselink ◽  
Annemien van den Bosch
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Systolic Function ◽  
Peak Systolic Velocity ◽  
Control Group ◽  
Imaging Method ◽  
Repaired Tetralogy Of Fallot ◽  
Detailed Assessment ◽  
Echocardiographic Assessment ◽  
Rv Function

Abstract Background In patients with repaired Tetralogy of Fallot (ToF), detailed assessment of right ventricular (RV) function is important for management and timing of possible pulmonary valve re-intervention. The aim of this study was to evaluate RV function using two-dimensional multi-plane echocardiography (2D MPE), a novel four-wall imaging method obtained from one apical acoustic window utilising electronic plane rotation. Methods and Results In sixty-two ToF patients (aged - 28 [22, 39] years, 65 % male), systolic function of four different RV walls (lateral, anterior, inferior and inferior coronal) were evaluated using MPE. Tricuspid annular plane systolic excursion (TAPSE), tricuspid annular peak systolic velocity (RV-S’) and RV wall longitudinal strain (RV-LS) measurements were compared with those of matched healthy individuals. 2D MPE measurements were highly feasible across the four RV walls (93.5-100% for TAPSE/S’; 66.1-95.1% for RV-LS) and could be performed more reliably than 3D RV ejection fraction (RVEF - 56.5%). All functional values were significantly reduced when compared to the control group (p<0.001). Higher RV-LS values were seen in the lateral (-17.8±4.5%) and inferior (-17.8±4.2%) walls compared to the anterior (-15.9±3.8%) and inferior coronal (-15.1±3.9%) walls. 3D RVEF correlated strongest with RV-LS values from the lateral (r -0.50; p=0.002) and anterior walls (r -0.74; p<0.001) and furthermore the four-wall average (r -0.57; p=0.001). Conclusion 2D MPE evaluation of the RV is highly feasible in ToF patients. This novel method provides new insights into regional RV wall function, enabling a more comprehensive and quantitative approach to RV assessment in daily clinical practice.

scholarly journals Circulation derived from 4D flow MRI correlates with right ventricular dysfunction in patients with tetralogy of Fallot

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Nanae Tsuchiya ◽  
Michinobu Nagao ◽  
Yumi Shiina ◽  
Shohei Miyazaki ◽  
Kei Inai ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Main Pulmonary Artery ◽  
Vortex Formation ◽  
Cine Mri ◽  
Short Axis ◽  
4D Flow Mri ◽  
4D Flow ◽  
Flow Mri ◽  
Rv Function

AbstractWe used 4D-flow MRI to investigate circulation, an area integral of vorticity, in the main pulmonary artery (MPA) as a new hemodynamic parameter for assessing patients with a repaired Tetralogy of Fallot (TOF). We evaluated the relationship between circulation, right ventricular (RV) function and the pulmonary regurgitant fraction (PRF). Twenty patients with a repaired TOF underwent cardiac MRI. Flow-sensitive 3D-gradient sequences were used to obtain 4D-flow images. Vortex formation in the MPA was visualized, with short-axis and longitudinal vorticities calculated by software specialized for 4D flow. The RV indexed end-diastolic/end-systolic volumes (RVEDVi/RVESVi) and RV ejection fraction (RVEF) were measured by cine MRI. The PR fraction (PRF) and MPA area were measured by 2D phase-contrast MRI. Spearman ρ values were determined to assess the relationships between circulation, RV function, and PRF. Vortex formation in the MPA occurred in 15 of 20 patients (75%). The longitudinal circulation (11.7 ± 5.1 m2/s) was correlated with the RVEF (ρ = − 0.85, p = 0.0002), RVEDVi (ρ = 0.62, p = 0.03), and RVESVi (ρ = 0.76, p = 0.003) after adjusting for the MPA size. The short-axis circulation (9.4 ± 3.4 m2/s) in the proximal MPA was positively correlated with the MPA area (ρ = 0.61, p = 0.004). The relationships between the PRF and circulation or RV function were not significant. Increased longitudinal circulation in the MPA, as demonstrated by circulation analysis using 4D flow MRI, was related to RV dysfunction in patients with a repaired TOF.

scholarly journals Assessment of right ventricular function during exercise echocardiography in adult patients with tetralogy of Fallot

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
J Peteiro ◽  
M Rivadulla-Varela ◽  
B Bouzas-Zubeldia ◽  
I Martinez-Bendayan ◽  
A Bouzas-Mosquera ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Ventricular Function ◽  
Tetralogy Of Fallot ◽  
Functional Capacity ◽  
Left Ventricular ◽  
Exercise Echocardiography ◽  
Tricuspid Annulus ◽  
Area Change ◽  
Metabolic Equivalents ◽  
Rv Function

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The evaluation of right ventricular (RV) function in patients with  tetralogy of Fallot (TF)  is important as it could impact outcome. Further exhaustive assessments with exercise might offer added information. We aimed to evaluate different parameters of RV function and their changes during exercise echocardiography (ExE) in patients with TF, and to correlate them with functional capacity Methods Treadmill ExE was performed in 31 consecutive patients with corrected TF (mean age 36 ± 11, 22 male), all of them asymptomatic. Left ventricular function was studied at peak exercise, whereas RV function parameters were acquired during the immediate post-exercise period (&lt;1.5 min), along with mitral, tricuspid and pulmonary regurgitation (PR), transtricuspid and transpulmonary systolic gradients, and LV-E/e´ values. RV function was assessed by tricuspid annulus plane systolic excursion (TAPSE), S wave velocity in the RV lateral annulus, and RV area change. A blunted functional capacity (BFC) was considered in case of achieving &lt;100% of the predicted metabolic equivalents (METs) during ExE, according to age and gender. Results Only 1 patient had symptoms during ExE (dyspnea). Achieved METs were 13 ± 3.5 and 10 patients (32%) had BFC. LV ejection fraction (%) changed with exercise from 58 ± 10 to 63 ± 9 (p = 0.05) and E/e´ from 11 ± 4 to 10 ± 3 (p = 0.04). TAPSE did not change (19 ± 5 at rest; 21 ± 7 at exercise; p = NS), neither RV area change (41 ± 11 cm2 at rest; 39 ± 12 cm2 at exercise; p = NS), whereas TDI-S increased from 10.5 ± 2.8 to 13.8 ± 3.1 cm2/s (p &lt; 0.001), and systolic pulmonary pressure from 20 ± 8 to 27 ± 12 mmHg (p = 0.001). Patients with BFC had more frequently significant PR at rest (60% vs 14%; p = 0.015), lower peak systolic blood pressure (152 ± 30 vs 176 ± 24 mmHg, p = 0.02) and higher exercise E/e´ (12.6 ± 2.7 vs 8.9 ± 3.0; p = 0.003), without differ in other parameters. Δ-TDI-S correlated with achieved METs and with the percent achieved of predicted METs (r = 0.46; p = 0.01, y r = 0.47; p = 0.008, respectively). In conclusion, TDI-S assessment at the tricuspid annulus is a useful parameter for assessing RV function during exercise in subjects with TF. Abstract Figure.

scholarly journals Mid- to long-term follow-up of pulmonary valve replacement with BioIntegral injectable valve

2020 ◽  
Author(s):  
Simone Ghiselli ◽  
Cristina Carro ◽  
Nicola Uricchio ◽  
Giuseppe Annoni ◽  
Stefano M Marianeschi
Keyword(s):  
Cardiopulmonary Bypass ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Stenosis ◽  
Pulmonary Regurgitation ◽  
Pulmonary Valve Replacement

Abstract OBJECTIVES Chronic pulmonary valve (PV) regurgitation is a common late sequela after repair of congenital heart diseases like tetralogy of Fallot or pulmonary stenosis, leading to right ventricular dilatation and failure and increased late morbidity and mortality. Timely reoperation may lead to a complete right ventricular recovery. An injectable PV allows pulmonary valve replacement, with or without cardiopulmonary bypass, under direct observation, thereby minimizing the impact of surgery on cardiac function. The aim of this study was to evaluate the feasibility and mid- to long-term clinical outcomes with this device. METHODS From April 2007 to October 2019, a total of 85 symptomatic patients with severe pulmonary regurgitation or pulmonary stenosis underwent pulmonary valve replacement with an injectable stented pulmonary prosthesis. Data were collected from the international proctoring registry. Mean patient age was 26.7 years. The underlying diagnosis was repaired tetralogy of Fallot in 69.4% patients; moderate or severe pulmonary regurgitation was present in 72.9%. All patients had echocardiographic scans before the operation and during the follow-up period. A total of 54.1% patients also had preoperative/postoperative cardiac magnetic resonance imaging (MRI) or catheterization; 25.9% had off-pump implants. In 53% patients, pulmonary valve replacement was associated with the repair of other cardiac defects. RESULTS Minor postoperative complications were observed in 10.8% patients. The overall mortality rate was 2.3%; mortality after valve replacement was linked to a severe cardiac insufficiency and it was not related to a prosthesis failure; 1 prosthesis was explanted from 1 patient because of endocarditis, and 6% of patients developed PV stenosis; minor complications occurred in 4.8%. The mean follow-up period was 4.8 years (2 months–12.7 years); 42% of the patients were followed for more than 5 years. Follow-up echocardiography and cardiac MRI showed a significant reduction in RV size and low gradients across the PV. CONCLUSIONS An injectable PV may be implanted without cardiopulmonary bypass and in a hybrid operating theatre with minimal surgical impact. The bioprosthesis, available up to large sizes, has a low profile, laminar flow and no risk of coronary artery compression. Incidence of endocarditis is rare. The lack of a suture ring permits the implant of a relatively larger prosthesis, thereby avoiding a right ventricular outflow tract obstruction. This device permits future percutaneous valve-in-valve procedures, if needed. Results concerning durability are encouraging, and mid- to long-term haemodynamic performance is excellent.

Abstract 12430: 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

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Atsuko Kato ◽  
Christian Drolet ◽  
Shi-Joon Yoo ◽  
Andrew Redington ◽  
Lars Grosse-Wortmann
Keyword(s):  
Pulmonary Artery ◽  
Tetralogy Of Fallot ◽  
Left Lung ◽  
Pulmonary Regurgitation ◽  
Left Pulmonary Artery ◽  
Flow Reversal ◽  
Left Hemithorax ◽  
Forward Flow ◽  
Lung Area ◽  
The Right

Introduction: The left pulmonary artery (LPA) contributes more than the right (RPA) to total pulmonary regurgitation (PR) in patients after tetralogy of Fallot (TOF) repair, but the mechanism of this difference is not well known. We hypothesized that unilaterally increased pulmonary vascular resistance (PVR), resulting from lung compression by the enlarged and levorotated heart leads to greater PR in the LPA. This study aimed to analyze the interplay between heart and lung size, mediastinal geometry, and differential PR. Methods: This is a single-center retrospective analysis of 50 magnetic resonance studies in patients after TOF repair. Patients with more than mild discrete branch pulmonary artery stenosis were excluded. Blood flow was measured by phase-contrast velocity encoding within the branch pulmonary arteries. On the axial image with the largest total cardiac surface area, cardiac angle (α) between the thoracic anterior-posterior line and the interventricular septum, right and left lung areas as well as right and left hemithorax areas were measured (Figure). Results: There was no difference in LPA and RPA diameters. The LPA showed significantly less total forward flow (p=0.04), smaller net forward flow (p=<0.001), and greater RF (p=0.001) than the RPA. Left lung area was smaller than the right (p<0.001). RVEDVi correlated with LPA RF (R=0.48, p<0.001), but not with RPA RF. Larger RVEDVi correlated with a larger α angle (R=0.46, p<0.001), i.e. a more leftward cardiac axis and with smaller left lung area (R=-0.58, p<0.001). LPA RF, but not RPA RF, correlated inversely with left lung area indexed to the left hemithorax area (R=-0.34, p=0.02). Conclusions: An enlarged and levorotated heart - as a result of PR - is associated with smaller left lung size, and augments diastolic flow reversal in the LPA, presumably via increased left PVR. By imposing a further volume load on the RV, LPA regurgitation may thus close a positive feed-back loop of PR and RV dilatation.

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