Assessment of Right Ventricular Inefficiency Using Energy Transfer Ratio in Repaired Tetralogy of Fallot

2011 ◽  
Author(s):  
Namheon Lee ◽  
Ashish Das ◽  
William M. Gottliebson ◽  
Rupak K. Banerjee
Keyword(s):  
Energy Transfer ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Main Pulmonary Artery ◽  
Pulmonary Regurgitation ◽  
Pulmonary Insufficiency ◽  
Control Group ◽  
Stroke Work ◽  
Transfer Ratio ◽  
Repaired Tetralogy Of Fallot

Pulmonary insufficiency (PI) induces pulmonary regurgitation and often leads to right ventricular (RV) enlargement and RV pressure overloading in repaired Tetralogy of Fallot (rTOF) patients. The appropriate timing of surgical treatments to renormalize RV function remains uncertain due to lack of suitable clinical diagnostic parameters. An energy transfer ratio (eMPA) between the net energy (Enet) transferred at main pulmonary artery (MPA) from RV and stroke work (SW) by RV was calculated using RV volume and pressure data for subjects in two study groups: the rTOF patient group (n = 7) and the control group (n = 7). Statistical analysis was performed to determine the difference of eMPA between the two groups. The mean eMPA for rTOF patients (0.64) was significantly lower (60.2%, p<0.05) than that of controls (1.61).

scholarly journals Altered biventricular hemodynamic forces in patients with repaired tetralogy of Fallot and right ventricular volume overload because of pulmonary regurgitation

2018 ◽  
Vol 315 (6) ◽  
pp. H1691-H1702 ◽  
Author(s):  
Pia Sjöberg ◽  
Johannes Töger ◽  
Erik Hedström ◽  
Per Arvidsson ◽  
Einar Heiberg ◽  
...  
Keyword(s):  
Blood Flow ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Flow Direction ◽  
Pulmonary Regurgitation ◽  
Ventricular Volume ◽  
Left Ventricular ◽  
Hemodynamic Forces ◽  
Control Subjects ◽  
Repaired Tetralogy Of Fallot

Intracardiac hemodynamic forces have been proposed to influence remodeling and be a marker of ventricular dysfunction. We aimed to quantify the hemodynamic forces in patients with repaired tetralogy of Fallot (rToF) to further understand the pathophysiological mechanisms as this could be a potential marker for pulmonary valve replacement (PVR) in these patients. Patients with rToF and pulmonary regurgitation (PR) > 20% ( n = 18) and healthy control subjects ( n = 15) underwent MRI, including four-dimensional flow. A subset of patients ( n = 8) underwent PVR and MRI after surgery. Time-resolved hemodynamic forces were quantified using 4D-flow data and indexed to ventricular volume. Patients had higher systolic and diastolic left ventricular (LV) hemodynamic forces compared with control subjects in the lateral-septal/LV outflow tract ( P = 0.011 and P = 0.0031) and inferior-anterior ( P < 0.0001 and P < 0.0001) directions, which are forces not aligned with blood flow. Forces did not change after PVR. Patients had higher RV diastolic forces compared with control subjects in the diaphragm-right ventricular (RV) outflow tract (RVOT; P < 0.001) and apical-basal ( P = 0.0017) directions. After PVR, RV systolic forces in the diaphragm-RVOT direction decreased ( P = 0.039) to lower levels than in control subjects ( P = 0.0064). RV diastolic forces decreased in all directions ( P = 0.0078, P = 0.0078, and P = 0.039) but were still higher than in control subjects in the diaphragm-RVOT direction ( P = 0.046). In conclusion, patients with rToF and PR had LV hemodynamic forces less aligned with intraventricular blood flow compared with control subjects and higher diastolic RV forces along the regurgitant flow direction in the RVOT and that of tricuspid inflow. Remaining force differences in the LV and RV after PVR suggest that biventricular pumping does not normalize after surgery. NEW & NOTEWORTHY Biventricular hemodynamic forces in patients with repaired tetralogy of Fallot and pulmonary regurgitation were quantified for the first time. Left ventricular hemodynamic forces were less aligned to the main blood flow direction in patients compared with control subjects. Higher right ventricular forces were seen along the pulmonary regurgitant and tricuspid inflow directions. Differences in forces versus control subjects remain after pulmonary valve replacement, suggesting that altered biventricular pumping does not normalize after surgery.

scholarly journals Study of the time-relationship of the mechano-electrical interaction in an animal model of tetralogy of Fallot: implications for the risk assessment of ventricular arrhythmias

2020 ◽  
Vol 31 (1) ◽  
pp. 129-137
Author(s):  
Thierry Bove ◽  
Rahi Alipour Symakani ◽  
Jonas Verbeke ◽  
Anne Vral ◽  
Milad El Haddad ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Ventricular Arrhythmias ◽  
Pulmonary Regurgitation ◽  
Left Ventricular ◽  
Monophasic Action Potential ◽  
Control Group ◽  
Stroke Work ◽  
Long Term Outcome ◽  
Intraventricular Conduction ◽  
Qrs Prolongation

Abstract OBJECTIVES The long-term outcome of tetralogy of Fallot (TOF) is determined by progressive right ventricular (RV) dysfunction through pulmonary regurgitation (PR) and the risk of malignant arrhythmia. Although mechano-electrical coupling in TOF is well-known, its time effect on the inducibility of arrhythmia remains ill-defined. The goal of this study was to investigate the mechano-electrical properties at different times in animals with chronic PR. METHODS PR was induced by a transannular patch with limited RV scarring in infant pigs. Haemodynamic assessment included biventricular pressure–volume loops after 3 (n = 8) and 6 months (n = 7) compared to controls (n = 5). The electrophysiological study included endocardial monophasic action potential registration, intraventricular conduction velocity and induction of ventricular arrhythmia by burst pacing. RESULTS Progressive RV dilation was achieved at 6 months (RV end-diastolic volume 143 ± 13 ml/m2—RV end-systolic volume 96 ± 7 ml/m2; P &lt; 0.001), in association with depressed RV contractility (preload recruitable stroke work-slope: 19 ± 1 and 11 ± 3 Mw.ml−1.s−1 for control and 6 m; P &lt; 0.001) and left ventricular contractility (preload recruitable stroke work-slope: 60 ± 13 and 40 ± 11 Mw.ml−1.s−1 for control and 6 m; P = 0.005). Concomitant to QRS prolongation, monophasic action potential90-duration and dispersion at the RV and left ventricle were increased at 6 months. Intraventricular conduction was delayed only in the RV at 6 months (1.8 ± 0.2 and 2.4 ± 0.6 m/s for group 6M and the control group; P = 0.035). Sustained ventricular arrhythmias were not inducible. CONCLUSIONS In animals yielding the sequelae of a contemporary operation for TOF, mechano-electrical alterations are progressive and affect predominantly the RV after midterm exposure of PR. Because ventricular arrhythmias were not inducible despite significant RV dilation, the data suggest that the haemodynamic RV deterioration effectively precedes the risk of inducing sustained arrhythmia after TOF repair and opens a window for renewed stratification of contemporary risk factors of ventricular arrhythmias in patients operated on with currently used pulmonary valve- and RV-related techniques.

scholarly journals Right ventricular systolic dysfunction but not dilatation correlates with prognostically significant reductions in exercise capacity in repaired Tetralogy of Fallot

2019 ◽  
Vol 21 (8) ◽  
pp. 906-913 ◽  
Author(s):  
Imran Rashid ◽  
Adil Mahmood ◽  
Tevfik F Ismail ◽  
Shamus O’Meagher ◽  
Shelby Kutty ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Exercise Capacity ◽  
Multivariable Analysis ◽  
Cardiopulmonary Exercise Testing ◽  
Pulmonary Regurgitation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Peak Vo2 ◽  
Repaired Tetralogy Of Fallot

Abstract Aims The optimal timing for pulmonary valve replacement in asymptomatic patients with repaired Tetralogy of Fallot (rTOF) and pulmonary regurgitation remains uncertain but is often guided by increases in right ventricular (RV) end-diastolic volume. As cardiopulmonary exercise testing (CPET) performance is a strong prognostic indicator, we assessed which cardiovascular magnetic resonance (CMR) parameters correlate with reductions in exercise capacity to potentially improve identification of high-risk patients. Methods and results In all, 163 patients with rTOF (mean age 24.5 ± 10.2 years) who had previously undergone CMR and standardized CPET protocols were included. The indexed right and left ventricular end-diastolic volumes (RVEDVi, LVEDVi), right and left ventricular ejection fractions (RVEF, LVEF), indexed RV stroke volume (RVSVi), and pulmonary regurgitant fraction (PRF) were quantified by CMR and correlated with CPET-determined peak oxygen consumption (VO2) or peak work. On univariable analysis, there was no significant correlation between RVEDVi and PRF with peak VO2 or peak work (% Jones-predicted). In contrast, RVEF and RVSVi had significant correlations with both peak VO2 and peak work that remained significant on multivariable analysis. For a previously established prognostic peak VO2 threshold of &lt;27 mL/kg/min, receiver-operating characteristic curve analysis demonstrated a Harrell’s c of 0.70 for RVEF (95% confidence interval 0.61–0.79) with a sensitivity of 88% for RVEF &lt;40%. Conclusion In rTOF, CMR indices of RV systolic function are better predictors of CPET performance than RV size. An RVEF &lt;40% may be useful to identify prognostically significant reductions in exercise capacity in patients with varying degrees of RV dilatation.

scholarly journals Progress of right ventricular dilatation in adults with repaired tetralogy of Fallot and free pulmonary regurgitation

2014 ◽  
Vol 3 ◽  
pp. 28-31 ◽  
Author(s):  
Shamus O’Meagher ◽  
Madhusudan Ganigara ◽  
David J. Tanous ◽  
David S. Celermajer ◽  
Rajesh Puranik
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Pulmonary Regurgitation ◽  
Ventricular Dilatation ◽  
Repaired Tetralogy Of Fallot ◽  
Right Ventricular Dilatation

Unexpected Internalization of a Pulmonary Artery Band in a Porcine Model of Tetralogy of Fallot

2016 ◽  
Vol 8 (1) ◽  
pp. 48-54 ◽  
Author(s):  
Zakaria Jalal ◽  
François Roubertie ◽  
Emmanuelle Fournier ◽  
Virginie Dubes ◽  
David Benoist ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Tetralogy Of Fallot ◽  
Histological Analysis ◽  
Porcine Model ◽  
Pulmonary Stenosis ◽  
Main Pulmonary Artery ◽  
Pulmonary Regurgitation ◽  
Inflammatory Cells ◽  
Pulmonary Insufficiency ◽  
Unusual Complication

Background: We report our experience of an unexpected complication of internalization of a pulmonary artery (PA) band in the vascular lumen, which occurred in a chronic porcine model of repaired tetralogy of Fallot (TOF). Methods: Twelve piglets were divided into 3 groups: (1) TOF model animals (PA band plus pulmonary valvotomy, n = 4), (2) pulmonary insufficiency (PI) animals (pulmonary valvotomy, n = 4), and (3) control animals (n = 4). A nonabsorbable, coated braided polyester tape was used to perform the main pulmonary artery banding. Echocardiography was performed 4 months postoperatively. After each animal was euthanized, PA histological analysis was performed in animals with band internalization. Results: Significant postsurgical pulmonary regurgitation and right ventricular enlargement were present in the TOF and PI, compared with control animals, whereas no significant pulmonary stenosis was observed in TOF animals when compared with PI group. Postmortem examination of all TOF animals revealed the constricting band to be intact but partially internalized into the PA lumen, allowing blood flow around the stenosis. Histological sections of the banded PA in the area of internalization showed a significant disorganization of the medial layer, with significant scarring and fibrotic reaction surrounding the outside of the band and the presence of inflammatory cells suggesting a significant inflammatory response during band internalization. Conclusions: Band internalization may occur after PA banding using a nonabsorbable, coated braided polyester tape in a chronic porcine model of repaired TOF. This unusual complication was likely due to the type of material used for banding.

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