Porcine Versus Pericardial Pulmonary Valve Replacement in Adults With Prior Congenital Cardiac Surgery: Midterm Outcomes

Background: Postcongenital heart surgery pulmonary regurgitation requires subsequent pulmonary valve replacement. We sought to compare the outcomes of pulmonary valve replacement after using bioprosthetic valves, porcine versus pericardial bioprosthesis. Method: Retrospective single-center study of consecutive pulmonary valve replacement in patients with pulmonary regurgitation following initial congenital cardiac surgery. From 2004 to 2016, 82 adult patients (53 males, 29 females) underwent pulmonary valve replacement at a mean age of 28.7 ± 8 years (range 18-52 years) with a mean time to pulmonary valve replacement of 24 ± 7 years (range 13-43 years). Porcine bioprosthetic valves (group 1, n = 32) and pericardial valves (group 2, n = 50) were used. Cardiac magnetic resonance imaging was performed (n = 54) at a mean of 18 ± 13 months before and 24 ± 21 months after pulmonary valve replacement. Results: No significant difference was seen between the groups except that the mean follow-up was longer for group 1 (5.02 ± 2.06 vs 4.08 ± 3.21 years). In-hospital mortality was 1.1%. Follow-up completeness was 100% with no late death. Mean right ventricular end-systolic and end-diastolic volumes reduced significantly in both the groups ( P < .001), whereas right ventricular ejection fraction remained unchanged (group 1, P = .129; group 2, P = .675) . Only the left ventricular end-diastolic volume increased in both the groups, but the increase was significant for group 2 only (group 1, P = .070; group 2, P = .015), whereas the left ventricular end-systolic and ejection fraction remained unchanged in both the groups. There was no reoperation for pulmonary valve replacement. Freedom from intervention was 93.8% (group 1) and 100% (group 2) at eight years after pulmonary valve replacement ( P = .407). Conclusion: Midterm outcomes of pulmonary valve replacement in our adult cohort were satisfactory. Both types of bioprosthetic valves performed comparably for eight years and were a good option in adults.

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Abstract 3124: Impact of Age on Outcome of Pulmonary Valve Replacement for Pulmonary Regurgitation

Circulation ◽

10.1161/circ.116.suppl_16.ii_701 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Alessandra Frigiola ◽

Victor Tsang ◽

Johannes Nordmeyer ◽

Philipp Lurz ◽

Kate Bull ◽

...

Keyword(s):

Ventricular Function ◽

Valve Replacement ◽

Pulmonary Valve ◽

Nyha Class ◽

Pulmonary Regurgitation ◽

Pulmonary Valve Replacement ◽

End Diastolic Volume ◽

Younger Age ◽

Group 2 ◽

Group 1

Objectives: Pulmonary valve replacement (PVR) for pulmonary regurgitation improves right ventricular function when performed relatively early. Effects on exercise performance are still controversial. Furthermore little attention has been given to the effects on left ventricular function. Methods: 60 patients (mean age 20.5 ± 10.4, 27 male, 77% tetralogy of Fallot) underwent pulmonary valve replacement (PVR). Indications for intervention were presence of severe PR (regurgitant fraction ≥ 35%) and RV/LV end-diastolic volume ≥1.5. Fifty-six patients had a pulmonary homograft (mean size 21.5±1.7 mm). Magnetic resonance imaging and cardiopulmonary exercise testing (CPEX) were performed prior to and 1 year after intervention. NYHA class was also recorded. Results: On a retrospective analysis, we found that Ve/VCO2 exercise parameter was most likely to normalize when PVR was performed at a younger age (< than 16 years, p=0.027). We therefore compared the results between the younger patients (group 1: n=24, 6 male, mean age of PVR 12±2.4 years) and the older patients (group 2: n=37, 21 male, mean age of PVR 26±10 years). Before intervention there were no differences in MR parameters. NYHA class was ≤ 2 in 83% of patients in group 1 vs 51% in group 2, p=0.01. Following PVR, only group 1 had a significant improvement in RV effective strove volume (40.9±8.7 to 47.1±7.1 mL/beat, p=0.001 vs 40.3±9.9 to 43.8±10.2, ns); in both groups there was a significant increase in LV end-diastolic volume, reflecting a better filling, and LV effective stroke volume (effSV), although these changes were more pronounced in group 1 (EDV: 11±11 vs 4±12 mL, p=0.041; effSV: 26±7 vs 19±11 mL/beat, p=0.025). Ve/VCO 2 improved significantly only in group 1 (33±3 to 30±4, p=0.015, vs 36±6 to 35±7, ns). Conclusions: PVR leads to a better RV and LV performance when performed at a younger age. This is mirrored by an improved Ve/VCO 2 exercise parameter which is more likely to normalize when surgery is performed prior to 16 year of age.

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A propensity score-adjusted analysis of clinical outcomes after pulmonary valve replacement in tetralogy of Fallot

Heart ◽

10.1136/heartjnl-2017-312048 ◽

2017 ◽

Vol 104 (9) ◽

pp. 738-744 ◽

Cited By ~ 44

Author(s):

Jouke P Bokma ◽

Tal Geva ◽

Lynn A Sleeper ◽

Sonya V Babu Narayan ◽

Rachel Wald ◽

...

Keyword(s):

Propensity Score ◽

Tetralogy Of Fallot ◽

Valve Replacement ◽

Primary Outcome ◽

Pulmonary Valve ◽

Pulmonary Regurgitation ◽

Pulmonary Valve Replacement ◽

Left Ventricular ◽

Secondary Outcome

ObjectiveTo determine the association of pulmonary valve replacement (PVR) with death and sustained ventricular tachycardia (VT) in patients with repaired tetralogy of Fallot (rTOF).MethodsSubjects with rTOF and cardiac magnetic resonance from an international registry were included. A PVR propensity score was created to adjust for baseline differences. PVR consensus criteria were predefined as pulmonary regurgitation >25% and ≥2 of the following criteria: right ventricular (RV) end-diastolic volume >160 mL/m2, RV end-systolic volume >80 mL/m2, RV ejection fraction (EF) <47%, left ventricular EF <55% and QRS duration >160 ms. The primary outcome included (aborted) death and sustained VT. The secondary outcome included heart failure, non-sustained VT and sustained supraventricular tachycardia.ResultsIn 977 rTOF subjects (age 26±15 years, 45% PVR, follow-up 5.3±3.1 years), the primary and secondary outcomes occurred in 41 and 88 subjects, respectively. The HR for subjects with versus without PVR (time-varying covariate) was 0.65 (95% CI 0.31 to 1.36; P=0.25) for the primary outcome and 1.43 (95% CI 0.83 to 2.46; P=0.19) for the secondary outcome after adjusting for propensity and other factors. In subjects (n=426) not meeting consensus criteria, the HR for subjects with (n=132) versus without (n=294) PVR was 2.53 (95% CI 0.79 to 8.06; P=0.12) for the primary outcome and 2.31 (95% CI 1.07 to 4.97; P=0.03) for the secondary outcome.ConclusionIn this large multicentre rTOF cohort, PVR was not associated with a reduced rate of death and sustained VT at an average follow-up of 5.3 years. Additionally, there were more events after PVR compared with no PVR in subjects not meeting consensus criteria.

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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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Abstract 9947: Predictors of Left Ventricular Dysfunction After Aortic Valve Replacement in Patients With Mixed Aortic Valve Disease

Circulation ◽

10.1161/circ.132.suppl_3.9947 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Alexander Egbe ◽

Joeseph Poterucha ◽

Carole Warnes

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Left Ventricular Dysfunction ◽

Aortic Valve Disease ◽

Ventricular Dysfunction ◽

Left Ventricular ◽

Group 2 ◽

Group 1

Objectives: Predictors of left ventricular dysfunction (LVD) after aortic valve replacement (AVR) in mixed aortic valve disease (MAVD) have not been studied. Objective was to determine prevalence and predictors of early and late LVD at 1 and 5 years post-AVR. Methods: Retrospective review of 247 patients (Age 63±8 years, males 81%) with moderate/severe MAVD who underwent AVR at the Mayo Clinic from 1994-2013. Only patients with follow-up data at 1 year post AVR were included (n=239). Cohort divided into 3 groups based on data collected prior to AVR, 1 and 5 years post AVR. LVD was defined as ejection fraction <50%. Results: LVD was present in 11/239 at baseline. At 1-year post AVR, 181 had normal EF (group 1) while 58/239 (24%) had early LVD (group 2). Predictors of LVD were atrial fibrillation (hazard ratio [HR] 1.83 confidence interval [CI] 1.59-1.98, p=0.001), age >70 years (HR: 3.12, CI: 2.33-4.18, p= <0.0001), CABG (HR: 2.17, CI: 2.24-5.93, p= <0.0001), and severe MAVD pre-operatively (HR: 2.87, CI: 2.33-3.17, p= 0.01), and hypertension (HR: 1.83, CI: 1.35-2.46, p= <0.0001). Prevalence of late LVD was 24% (47/197-group 3) and LVMI at 1 year post AVR was predictive of late LVD (HR 1.65, CI 1.11-3.8 per 10 g/ m 2 increment, p= 0.04)). Group 2 had less reverse LV remodeling compared to group 1 at 1 year post AVR (142±39 vs 129±42 g/ m 2 , p=0.02). Conclusions: Risk of LVD was significant even in subset of patients with moderate MAVD. Risk stratification of MAVD should be based on both clinical and echocardiographic parameters. Our data suggest earlier surgical intervention may be required in the MAVD population to prevent postoperative LVD but further studies are needed. Figure legend: FU: follow up

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Surgically treated pulmonary stenosis: over 50 years of follow-up

Cardiology in the Young ◽

10.1017/s1047951115001158 ◽

2015 ◽

Vol 26 (5) ◽

pp. 860-866 ◽

Cited By ~ 9

Author(s):

Eva A. Nielsen ◽

Vibeke E. Hjortdal

Keyword(s):

Right Ventricular ◽

Valve Replacement ◽

Tricuspid Regurgitation ◽

Pulmonary Valve ◽

Pulmonary Stenosis ◽

Pulmonary Regurgitation ◽

Pulmonary Valve Replacement ◽

Ventricular Dilatation ◽

Right Ventricular Dilatation

AbstractBackgroundSurgical correction was the treatment of choice for pulmonary stenosis until three decades ago, when balloon valvuloplasty was implemented. The natural history of surgically relieved pulmonary stenosis has been considered benign but is actually unknown, as is the need for re-intervention.The objective of this study was to investigate the morbidity and mortality of patients with surgically treated pulmonary stenosis operated at Aarhus University Hospital between 1957 and 2000.ResultsThe total study population included 80 patients. In-hospital mortality was 2/80 (2.5%), and an additional four patients died after hospital discharge; therefore, the long-term mortality was 5%. The maximum follow-up period was 57 years, with a median of 33 years. In all, 16 patients (20%) required at least one re-intervention. Pulmonary valve replacement due to pulmonary regurgitation was the most common re-intervention (67%). Freedom from re-intervention decreased >20 years after the initial repair. In addition, 45% of patients had moderate/severe pulmonary regurgitation, 38% had some degree of right ventricular dilatation, and 40% had some degree of tricuspid regurgitation, which did not require re-intervention at the present stage.ConclusionSurgical relief for pulmonary stenosis is efficient in relieving outflow obstruction; however, this efficiency is achieved at the cost of pulmonary regurgitation, leading to right ventricular dilatation and tricuspid regurgitation. When required, pulmonary valve replacement is performed most frequently >20 years after the initial surgery. Lifelong follow-up of patients treated surgically for pulmonary stenosis is emphasised in this group of patients, who might otherwise consider themselves cured.

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Abstract 3126: Pulmonary Valve Replacement In Chronic Pulmonary Regurgitation In Adults With Congenital Heart Disease: Influence Of Preoperative QRS-duration On Postoperative Right Ventricular Function

Circulation ◽

10.1161/circ.116.suppl_16.ii_701-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Mechthild Westhoff-Bleck ◽

Girke Stefan ◽

Thomas Breymann ◽

Joachim Lotz ◽

Stafanie Pertsch ◽

...

Keyword(s):

Ejection Fraction ◽

Right Ventricular ◽

Valve Replacement ◽

Pulmonary Valve ◽

Pulmonary Regurgitation ◽

Pulmonary Valve Replacement ◽

Cardiorespiratory Function ◽

Qrs Duration ◽

Rv Function

Background: Chronic pulmonary regurgitation (PR) causes progressive right ventricular (RV) dysfunction and heart failure. Parameters defining the optimal time point for surgery of chronic PR are lacking. The present study prospectively evaluated the impact of clinical parameters, cardiorespiratory function and neurohumoral activation on post operative RV function and volumes assessed with magnetic resonance imaging (MRI) after pulmonary valve replacement in patients with severe PR. Methods and Results: MRI was performed preoperatively and at follow-up 5.2±3.5months after surgery in 27 patients (23.6±2.9 years, 15 women) with severe PR. Underlying cardiac disease was repaired Tetralogy of Fallot (n=22), Double outlet right ventricle (n=3) and PR after pulmonary valvulotomy (n=2). Postoperatively, RV endsystolic (RVESVI) and enddiastolic volume indices (RVEDVI) decreased significantly (RVESVI pre 78,2±20,4 ml/m 2 BSA vs. RVESVI post 52,2±16,8 ml/m 2 BSA, p<0,001; RVEDVI pre 150,7±27,7 ml/m 2 BSA vs. RVEDVI post 105,7±26,7 ml/m 2 BSA; p<0,001). Mean RV ejection fraction (RVEF) remained unchanged in the study cohort (47.6 ± 8.7% vs. 49.7 ±7.0%, n.s.). Preoperative volumes did not correlate with postoperative ejection fraction. With increasing preoperative QRS-duration, postoperative RVEF decreased significantly (r=−0.57; p<0,005). A preoperative QRS-duration smaller than the median (156ms) predicted an improved RVEF as compared to a QRS-duration ≤ 156ms (54.9% vs. 46.8%, p<0.05). Neither elevated NT-proBNP levels nor reduced cardiorespiratory function were able to predict postoperative RVEF. Conclusion: Valve replacement in severe pulmonary regurgitation causes significant reduction of RV volumes. Prolonged preoperative QRS-duration was associated with a worse outcome with respect to postoperative RVEF. During follow-up an increase in QRS-duration in patients with chronic PR might indicate deterioration in RV function reflecting a risk of impaired RV function postoperatively.

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Changes in left and right ventricular longitudinal function after pulmonary valve replacement in patients with Tetralogy of Fallot

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00417.2019 ◽

2020 ◽

Vol 318 (2) ◽

pp. H345-H353 ◽

Cited By ~ 1

Author(s):

Pia Sjöberg ◽

Ellen Ostenfeld ◽

Erik Hedström ◽

Håkan Arheden ◽

Ronny Gustafsson ◽

...

Keyword(s):

Tetralogy Of Fallot ◽

Valve Replacement ◽

Pulmonary Valve ◽

Pulmonary Regurgitation ◽

Pulmonary Valve Replacement ◽

Left Ventricular ◽

Longitudinal Function ◽

Before And After ◽

Atrioventricular Plane Displacement ◽

Plane Displacement

Timing and indication for pulmonary valve replacement (PVR) in patients with repaired Tetralogy of Fallot (rToF) and pulmonary regurgitation (PR) are uncertain. To improve understanding of pumping mechanics, we investigated atrioventricular coupling before and after surgical PVR. Cardiovascular magnetic resonance was performed in patients ( n = 12) with rToF and PR > 35% before and after PVR and in healthy controls ( n = 15). Atrioventricular plane displacement (AVPD), global longitudinal peak systolic strain (GLS), atrial and ventricular volumes, and caval blood flows were analyzed. Right ventricular (RV) AVPD and RV free wall GLS were lower in patients before PVR compared with controls ( P < 0.0001; P < 0.01) and decreased after PVR ( P < 0.0001 for both). Left ventricular AVPD was lower in patients before PVR compared with controls ( P < 0.05) and decreased after PVR ( P < 0.01). Left ventricular GLS did not differ between patients and controls ( P > 0.05). Right atrial reservoir volume and RV stroke volume generated by AVPD correlated in controls ( r = 0.93; P < 0.0001) and patients before PVR ( r = 0.88; P < 0.001) but not after PVR. In conclusion, there is a clear atrioventricular coupling in patients before PVR that is lost after PVR, possibly because of loss of pericardial integrity. Impaired atrioventricular coupling complicates assessment of ventricular function after surgery using measurements of longitudinal function. Changes in atrioventricular coupling seen in patients with rToF may be energetically unfavorable, and long-term effects of surgery on atrioventricular coupling is therefore of interest. Also, AVPD and GLS cannot be used interchangeably to assess longitudinal function in rToF. NEW & NOTEWORTHY There is a clear atrioventricular coupling in patients with Tetralogy of Fallot (ToF) and pulmonary regurgitation before surgical pulmonary valve replacement (PVR) that is lost after operation, possibly because of loss of pericardial integrity. The impaired atrioventricular coupling complicates assessment of ventricular function after surgery when using measurements of longitudinal function. Left ventricular atrioventricular plane displacement (AVPD) found differences between patients and controls and changes after PVR that longitudinal strain could not detect. This indicates that AVPD and strain cannot be used interchangeably to assess longitudinal function in repaired ToF.

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Usefulness of maximal oxygen pulse in timing of pulmonary valve replacement in patients with isolated pulmonary regurgitation

Cardiology in the Young ◽

10.1017/s1047951115002504 ◽

2015 ◽

Vol 26 (7) ◽

pp. 1310-1318 ◽

Cited By ~ 6

Author(s):

Antoine Legendre ◽

Ruddy Richard ◽

Florence Pontnau ◽

Jean-Philippe Jais ◽

Marc Dufour ◽

...

Keyword(s):

Right Ventricular ◽

Valve Replacement ◽

Pulmonary Valve ◽

Pulmonary Regurgitation ◽

Pulmonary Valve Replacement ◽

Left Ventricular ◽

Ventricular Performance ◽

Predictive Values ◽

Oxygen Pulse ◽

The Impact

Patients with pulmonary regurgitation after tetralogy of Fallot repair have impaired aerobic capacity; one of the reasons is the decreasing global ventricular performance at exercise, reflected by decreasing peak oxygen pulse. The aims of our study were to evaluate the impact of pulmonary valve replacement on peak oxygen pulse in a population with pure pulmonary regurgitation and with different degrees of right ventricular dilatation and to determine the predictors of peak oxygen pulse after pulmonary valve replacement.The mean and median age at pulmonary valve replacement was 27 years. Mean pre-procedural right ventricular end-diastolic volume was 182 ml/m2. Out of 24 patients, 15 had abnormal peak oxygen pulse before pulmonary valve replacement. We did not observe a significant increase in peak oxygen pulse after pulmonary valve replacement (p=0.76). Among cardiopulmonary test/MRI/historical pre-procedural parameters, peak oxygen pulse appeared to be the best predictor of peak oxygen pulse after pulmonary valve replacement (positive and negative predictive values, respectively, 0.94 and 1). After pulmonary valve replacement, peak oxygen pulse was well correlated with left ventricular stroke and end-diastolic volumes (r=0.67 and 0.68, respectively).Our study confirms the absence of an effect of pulmonary valve replacement on peak oxygen pulse whatever the initial right ventricular volume, reflecting possible irreversible right and/or left ventricle lesions. Pre-procedural peak oxygen pulse seemed to well predict post-procedural peak oxygen pulse. These results encourage discussions on pulmonary valve replacement in patients showing any decrease in peak oxygen pulse during their follow-up.

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Abstract 16647: Left Ventricular Electro-Mechanical Discoordination is Present in Patients With Tetralogy of Fallot Not Meeting Conventional Criteria for Pulmonary Valve Replacement

Circulation ◽

10.1161/circ.142.suppl_3.16647 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Alexis L Gerk ◽

Michal Schafer ◽

Benjamin Frank ◽

Johannes von Alvensleben ◽

Dunbar D IVY ◽

...

Keyword(s):

Tetralogy Of Fallot ◽

Valve Replacement ◽

Pulmonary Valve ◽

Pulmonary Regurgitation ◽

Ventricular Myocardium ◽

Myocardial Contraction ◽

Pulmonary Valve Replacement ◽

Left Ventricular ◽

Lv Function ◽

Strain And Strain Rate

Introduction: Pulmonary regurgitation (PR) and RV dilation influence timing of pulmonary valve replacement (PVR) in patients with repaired Tetralogy of Fallot (rTOF). LV function is an independent marker of TOF patient outcomes. New markers of electromechanical discoordination (EMD) have recently been described. Systolic stretch fraction (SSF) quantifies the ratio of ventricular myocardium inappropriately relaxing during systole. Diastolic relaxation fraction (DRF) quantifies inappropriate myocardial contraction during diastole. We analyzed LV EMD using SSF and DRF in rTOF patients with PR who do not meet commonly used criteria for PVR with mild to moderate RV dilation (<150 mL/m 2 ). Hypothesis: Patients with rTOF will have abnormal LV EMD. Methods: Patients (n=18) and healthy controls (n=20) with rTOF and PR underwent cardiac MRI. LV EMD was analyzed using SSF and DRF (Figure) derived from strain and strain rate analysis considering individual LV myocardial segments. Rank-sum test was used to compare groups. SSF and DRF were assessed for linear correlations with RVEDVi by Pearson method. Results: There were 9 male and 9 female TOF patients (Mdn age 15, range 9-55). TOF patients had increased RVEDVi (118±23 ml/m 2 , p<0.001) and increased RVESVi (56±13 ml/m 2 , p<0.001) compared to controls. RV EF was lower in TOF patients but within normal physiologic range (53±6%, p=0.008). LV size indices and EF did not differ. TOF patients had increased SSF (Mdn 0.035, IQR 0.015-0.052, p=0.002) and significantly decreased DRF (Mdn 2.735, IQR 2.358-2.959, p<0.0001). RVEDVi correlated with increased SSF (R=0.51, p=0.011) and decreased DRF (R=0.62, p=0.007). Conclusions: TOF patients with PR and mild to moderate RV dilation have significant LV EMD during both systole and diastole. The degree of systolic and diastolic EMD correlate with RV dilation. SSF and DRF are unique and sensitive early markers of LV dysfunction compared to conventional MRI metrics.

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Impact of pulmonary valve replacement on left ventricular rotational mechanics in repaired tetralogy of Fallot

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/s12968-021-00750-3 ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Jamie K. Harrington ◽

Sunil Ghelani ◽

Nikhil Thatte ◽

Anne Marie Valente ◽

Tal Geva ◽

...

Keyword(s):

Tetralogy Of Fallot ◽

Valve Replacement ◽

Feature Tracking ◽

Pulmonary Valve ◽

Pulmonary Regurgitation ◽

Pulmonary Valve Replacement ◽

Left Ventricular ◽

Control Subjects ◽

Repaired Tetralogy Of Fallot ◽

Rotational Mechanics

Abstract Background In repaired tetralogy of Fallot (rTOF), abnormal left ventricular (LV) rotational mechanics are associated with adverse clinical outcomes. We performed a comprehensive analysis of LV rotational mechanics in rTOF patients using cardiac magnetic resonance (CMR) prior to and following surgical pulmonary valve replacement (PVR). Methods In this single center retrospective study, we identified rTOF patients who (1) had both a CMR ≤ 1 year before PVR and ≤ 5 years after PVR, (2) had no other intervening procedure between CMRs, (3) had a body surface area > 1.0 m2 at CMR, and (4) had images suitable for feature tracking analysis. These subjects were matched to healthy age- and sex-matched control subjects. CMR feature tracking analysis was performed on a ventricular short-axis stack of balanced steady-state free precession images. Measurements included LV basal and apical rotation, twist, torsion, peak systolic rates of rotation and torsion, and timing of events. Associations with LV torsion were assessed. Results A total of 60 rTOF patients (23.6 ± 7.9 years, 52% male) and 30 healthy control subjects (20.8 ± 3.1 years, 50% male) were included. Compared with healthy controls, rTOF patients had lower apical and basal rotation, twist, torsion, and systolic rotation rates, and these parameters peaked earlier in systole. The only parameters that were correlated with LV torsion were right ventricular (RV) end-systolic volume (r = − 0.28, p = 0.029) and RV ejection fraction (r = 0.26, p = 0.044). At a median of 1.0 year (IQR 0.5–1.7) following PVR, there was no significant change in LV rotational parameters versus pre-PVR despite reductions in RV volumes, RV mass, pulmonary regurgitation, and RV outflow tract obstruction. Conclusion In this comprehensive study of CMR-derived LV rotational mechanics in rTOF patients, rotation, twist, and torsion were diminished compared to controls and did not improve at a median of 1 year after PVR despite favorable RV remodeling.

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