scholarly journals 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

2016 ◽  
Vol 18 (1) ◽  
Author(s):  
Atsuko Kato ◽  
Christian Drolet ◽  
Shi-Joon Yoo ◽  
Andrew N. Redington ◽  
Lars Grosse-Wortmann
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Pulmonary Regurgitation ◽  
Left Pulmonary Artery ◽  
Flow Reversal ◽  
Vicious Circle ◽  
Right Heart ◽  
Right Ventricular Dilatation ◽  
Tetralogy Of Fallot Repair

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.

scholarly journals Rapid Fire Abstract session: assessing the single ventricule and new techniques for assessing tetralogy477Echocardiographic assessment of ventricular function and predictors of mortality in adults with a Fontan circulation478The left pulmonary artery doppler in the assessment of atrial restriction after the hybrid procedure for hypoplastic left heart syndrome479Magnetic resonance imaging in patients with Fontan physiology detects a high prevalence of liver lesions480NT-proBNP as marker of right ventricular dilatation and pulmonary regurgitation after surgical correction of tetralogy of fallot481Right ventricular postsystolic shortening is associated with diastolic dysfunction in children after tetralogy of fallot repair.482Multimodality assessment of the ascending aorta after tetralogy of Fallot repair483Is there an arterial-ventricular coupling in tetralogy of Fallot?484Diastolic dysfunction is related to myocardial remodeling of the systemic right ventricle and neurohormonal activation in adults with transposition of the great arteries palliated by atrial switch.

2015 ◽  
Vol 16 (suppl 2) ◽  
pp. S56-S58 ◽  
Author(s):  
R Cordina ◽  
H Bellsham-Revell ◽  
J Melero Ferrer ◽  
Valverde Perez ◽  
R Pietrzak ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Pulmonary Regurgitation ◽  
Left Pulmonary Artery ◽  
New Techniques ◽  
Systemic Right Ventricle ◽  
Atrial Switch ◽  
High Prevalence ◽  
Fontan Physiology ◽  
Right Ventricular Dilatation ◽  
Tetralogy Of Fallot Repair

scholarly journals NT-proBNP as a biomarker of right ventricular dilatation and pulmonary regurgitation in Tetralogy of Fallot

2015 ◽  
Vol 17 (S1) ◽  
Author(s):  
Israel Valverde ◽  
Annalisa Paolino ◽  
Maria Pilar Serrano Gotarredona ◽  
Silvia Navarro ◽  
Nieves Romero ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Pulmonary Regurgitation ◽  
Ventricular Dilatation ◽  
Right Ventricular Dilatation

Flow Energy Loss as a Predictive Parameter for Right Ventricular Deterioration Caused by Pulmonary Regurgitation After Tetralogy of Fallot Repair

2018 ◽  
Vol 39 (4) ◽  
pp. 731-742 ◽  
Author(s):  
Miyuki Shibata ◽  
Keiichi Itatani ◽  
Taiyu Hayashi ◽  
Takashi Honda ◽  
Atsushi Kitagawa ◽  
...  
Keyword(s):  
Energy Loss ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Pulmonary Regurgitation ◽  
Flow Energy ◽  
Flow Energy Loss ◽  
Tetralogy Of Fallot Repair

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

Stenting of the right ventricular outflow tract in symptomatic neonatal tetralogy of Fallot

2013 ◽  
Vol 24 (2) ◽  
pp. 369-373 ◽  
Author(s):  
Nikolaus A. Haas ◽  
Thorsten K. Laser ◽  
Axel Moysich ◽  
Ute Blanz ◽  
Eugen Sandica
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Pulmonary Regurgitation ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Ventricular Performance ◽  
Right Ventricular Performance ◽  
The Right

AbstractThere is ongoing debate regarding the initial management of symptomatic neonates with tetralogy of Fallot. Although neonatal repair can be performed with low mortality, it is associated with increased morbidity and long-term impact on right ventricular performance. Traditionally, the modified Blalock–Taussig shunt remains the palliative procedure of choice. Differential pulmonary artery flow may occur and subsequently result in underdevelopment and distortion of pulmonary vessels. Transcatheter therapy was previously limited to balloon valvulotomy when the obstruction is predominantly at the pulmonary valve level. Stenting of the right ventricular outflow tract can enable adequate forward flow; however, pulmonary regurgitation may impact on right ventricular performance and cardiac output. Stenting of the right ventricular outflow tract with valve sparing placement of the stent thus treating the underlying pathophysiology of the hypercyanotic spells provides a safe and effective management strategy, improving arterial oxygen saturation, avoiding pulmonary regurgitation and encouraging pulmonary artery growth.

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