Real-time video kinematic evaluation of the in situ beating right ventricle after pulmonary valve replacement in patients with tetralogy of Fallot: a pilot study

Abstract OBJECTIVES The timing for pulmonary valve replacement (PVR) after tetralogy of Fallot repair is controversial, due to limitations in estimating right ventricular dysfunction and recovery. Intraoperative imaging could add prognostic information, but transoesophageal echocardiography is unsuitable for exploring right heart function. Right ventricular function after PVR was investigated in real time using a novel video-based contactless kinematic evaluation technology (Vi.Ki.E.), which calculates cardiac fatigue and energy consumption. METHODS Six consecutive patients undergoing PVR at 13.8 ± 2.6 years (range 6.9–19.8) after the repair of tetralogy of Fallot were enrolled. Mean right ventricular end-diastolic and end-systolic volume at magnetic resonance imaging were 115.6 ± 16.2 ml/m2 and 61.5 ± 14.6 ml/m2, respectively. Vi.Ki.E. uses a fast-resolution camera placed 45 cm above the open chest, recording cardiac kinematics before and after PVR. An algorithm defines cardiac parameters, such as energy, fatigue, maximum contraction velocity and tissue displacement. RESULTS There were no perioperative complications, with patients discharged in satisfactory clinical conditions after 7 ± 2 days (range 5–9). Vi.Ki.E. parameters describing right ventricular dysfunction decreased significantly after surgery: energy consumption by 45% [271 125 ± 9422 (mm/s)2 vs 149 202 ± 11 980 (mm/s)2, P = 0.0001], cardiac fatigue by 12% (292 671 ± 29 369 mm/s2 vs 258 755 ± 42 750 mm/s2, P = 0.01), contraction velocity by 54% (3412 ± 749 mm/s vs 1579 ± 400 mm/s, P = 0.0007) and displacement by 23% (27 ± 4 mm vs 21 ± 4 mm, P = 0.01). Patients undergoing PVR at lower end-diastolic volumes, had greater functional recovery of Vi.Ki.E. parameters. CONCLUSIONS Intraoperative Vi.Ki.E shows immediate recovery of right ventricular mechanics after PVR with less cardiac fatigue and energy consumption, providing novel insights that may have a prognostic relevance for functional recovery.

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Right ventricular dysfunction and pulmonary valve replacement after correction of tetralogy of fallot

The Annals of Thoracic Surgery ◽

10.1016/s0003-4975(02)03586-5 ◽

2002 ◽

Vol 73 (6) ◽

pp. 1794-1800 ◽

Cited By ~ 84

Author(s):

Frank T.H. de Ruijter ◽

Ineke Weenink ◽

Francois J. Hitchcock ◽

Erik J. Meijboom ◽

Ger B.W.E. Bennink

Keyword(s):

Right Ventricular ◽

Tetralogy Of Fallot ◽

Valve Replacement ◽

Ventricular Dysfunction ◽

Pulmonary Valve ◽

Right Ventricular Dysfunction ◽

Pulmonary Valve Replacement

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Right ventricular functional recovery depends on timing of pulmonary valve replacement in tetralogy of Fallot: a video kinematic study

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezab026 ◽

2021 ◽

Author(s):

Giacomo Rozzi ◽

Francesco Paolo Lo Muzio ◽

Lorenzo Fassina ◽

Stefano Rossi ◽

Rosario Statello ◽

...

Keyword(s):

Magnetic Resonance ◽

Tetralogy Of Fallot ◽

Valve Replacement ◽

Functional Recovery ◽

Pulmonary Valve ◽

Pulmonary Valve Replacement ◽

Volume Index ◽

End Diastolic Volume ◽

Kinematic Evaluation ◽

Tetralogy Of Fallot Repair

Abstract OBJECTIVES Indications for and timing of pulmonary valve replacement (PVR) after tetralogy of Fallot repair are controversial. Among magnetic resonance imaging indices proposed to time valve replacement, a right ventricular (RV) end-diastolic volume index greater than 160 ml/m2 is often used. Recent evidence suggests that this value may still identify patients with irreversible RV dysfunction, thus hindering recovery. Our goal was to define, using intraoperative video kinematic evaluation, whether a relationship exists between timing of PVR and early functional recovery after surgery. METHODS Between November 2016 and November 2018, a total of 12 consecutive patients aged 27.1 ± 19.1 years underwent PVR on average 22.2 ± 13.3 years after tetralogy of Fallot repair. Mean RV end-diastolic volume evident on the magnetic resonance images was 136.9 ± 35.7 ml/m2. Intraoperative cardiac kinematics were assessed by video kinematic evaluation via a high-speed camera acquiring videos at 200 fps before and after valve replacement. RESULTS Patients presenting with RV end-diastolic volume <147 ml/m2 were significantly younger (11.2 ± 5.0 vs 38.4 ± 17.0; P = 0.005) and had a shorter time interval to valve replacement (11.0 ± 5.2 vs 30.1 ± 11.3; P = 0.03). The entire population showed a moderate correlation among energy expenditure, cardiac fatigue, perimeter of contraction and preoperative RV end-diastolic volume index. Both groups showed a reduction in all kinematic parameters after PVR, but those with end-diastolic volume >147 ml/m2 showed an unpredictable outcome. CONCLUSIONS Video kinematic evaluation provides insight into intraoperative RV recovery in patients with tetralogy of Fallot undergoing PVR. Accordingly, functional recovery can be expected in patients with preoperative end-diastolic volume <147 ml/m2.

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Contemporary Outcomes in Tetralogy of Fallot With Absent Pulmonary Valve After Fetal Diagnosis

Journal of the American Heart Association ◽

10.1161/jaha.120.019713 ◽

2021 ◽

Author(s):

Anjali Chelliah ◽

Anita J. Moon‐Grady ◽

Shabnam Peyvandi ◽

Joanne S. Chiu ◽

James E. Bost ◽

...

Keyword(s):

Right Ventricular ◽

Tetralogy Of Fallot ◽

Left Ventricular Dysfunction ◽

Ventricular Dysfunction ◽

Pulmonary Valve ◽

Right Ventricular Dysfunction ◽

Left Ventricular ◽

Absent Pulmonary Valve ◽

Intention To Treat ◽

Overall Mortality

Background Tetralogy of Fallot with absent pulmonary valve is associated with high mortality, but it remains difficult to predict outcomes prenatally. We aimed to identify risk factors for mortality in a large multicenter cohort. Methods and Results Fetal echocardiograms and clinical data from 19 centers over a 10‐year period were collected. Primary outcome measures included fetal demise and overall mortality. Of 100 fetuses, pregnancy termination/postnatal nonintervention was elected in 22. Of 78 with intention to treat, 7 (9%) died in utero and 21 (27%) died postnatally. With median follow‐up of 32.9 months, no deaths occurred after 13 months. Of 80 fetuses with genetic testing, 46% had chromosomal abnormalities, with 22q11.2 deletion in 35%. On last fetal echocardiogram, at a median of 34.6 weeks, left ventricular dysfunction independently predicted fetal demise (odds ratio [OR], 7.4; 95% CI 1.3, 43.0; P =0.026). Right ventricular dysfunction independently predicted overall mortality in multivariate analysis (OR, 7.9; 95% CI 2.1–30.0; P =0.002). Earlier gestational age at delivery, mediastinal shift, left ventricular/right ventricular dilation, left ventricular dysfunction, tricuspid regurgitation, and Doppler abnormalities were associated with fetal and postnatal mortality, although few tended to progress throughout gestation on serial evaluation. Pulmonary artery diameters did not correlate with outcomes. Conclusions Perinatal mortality in tetralogy of Fallot with absent pulmonary valve remains high, with overall survival of 64% in fetuses with intention to treat. Right ventricular dysfunction independently predicts overall mortality. Left ventricular dysfunction predicts fetal mortality and may influence prenatal management and delivery planning. Mediastinal shift may reflect secondary effects of airway obstruction and abnormal lung development and is associated with increased mortality.

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

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa337 ◽

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.

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