scholarly journals Speckle tracking echocardiography before and after Surgical pulmonary valve replacement in Tetralogy of Fallot patients: Can STE elucidate early left ventricular dysfunction?

2020 ◽  
Author(s):  
Gholam Hossein Ajami ◽  
Fathi Alwasabi ◽  
Nima Mehdizadegan ◽  
Mohammad Reza Edraki ◽  
Hamid Mohammadi ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Pulmonary Valve ◽  
Pulmonary Valve Replacement ◽  
Left Ventricular ◽  
Control Group ◽  
Lv Function ◽  
Repaired Tetralogy Of Fallot ◽  
2D Echocardiography

Abstract Objectives: TOF is the most common cyanotic CHD. We investigated left ventricular (LV) function after surgical pulmonary valve replacement (sPVR) in patients with repaired Tetralogy of Fallot (rTOF) by Speckle Tracking Echocardiography (STE).Methods: 58 volunteers participated in this study who divided into 3 groups including 22 PVR patients (mean age 18.96±7 year), 16 repaired Tetralogy of Fallot and 20 healthy age match control. For all patients, we performed 2D echocardiography and STE.Results: 2D echocardiography in all groups showed normal LV ejection fraction without a significant statistical difference (64% sPVR, 60% in repaired Tetralogy of Fallot and 62.5% in the control group). However, the mean global longitudinal strains (GLS) of LV were significantly reduced in both sPVR (-17.5±2.5%) and repaired Tetralogy of Fallot (-17.1±4.7%) patients rather than control group (-20.2±0.7%) (P = 0.003). But GLS had no statistically significant difference between repaired Tetralogy of Fallot and sPVR patients (P=0.9). Segmental analysis of longitudinal strain (LS) showed a significant decrease in sPVR patients and repaired Tetralogy of Fallot group in basal anterior, basal septal, basal anterolateral segments, mid-anterior and anterolateral segments. Except for lower LS in the apical-anteroseptal segment, this level was mostly spared in both sPVR and repaired Tetralogy of Fallot patients.Conclusion: LVEF was within normal range after sPVR patients, but the pattern of impaired segmental LS and GLS did not change as compared with rTOF. Surgical PVR in patients with repaired TOF may not have a significant effect on the improvement of LV function assessed by STE. LV damage which happens during surgical correction of TOF may have a permanent deteriorating effect on LV function.

scholarly journals Right Ventricular Strain in Repaired Tetralogy of Fallot After Pulmonary Valve Replacement With Reconstructed Radial Long-axis Cine Magnetic Resonance Images

2021 ◽  
Author(s):  
Masateru Kawakubo ◽  
Yuzo Yamasaki ◽  
Daisuke Toyomura ◽  
Kenichiro Yamamura ◽  
Ichiro Sakamoto ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Valve Replacement ◽  
Control Group ◽  
Short Axis ◽  
Short Axis Cine ◽  
Repaired Tetralogy Of Fallot ◽  
Before And After

Abstract Objectives: To investigate changes in right ventricular (RV) strain after pulmonary valve replacement (PVR) in repaired tetralogy of Fallot (TOF) by applying a novel postprocessing technique to conventional short-axis cine MRI to measure RV strains before and after PVR.Methods: Twenty-four patients with repaired TOF who underwent PVR and 16 healthy controls were enrolled. Global maximum and minimum principal strains (GPSmax, GPSmin) and global circumferential and longitudinal strains (GCS, GLS) were measured from short-axis cine images reconstructed radially along the long axis. Strain parameters before and after PVR were compared using paired t-tests. One-way ANOVA with Tukey post-hoc analysis was used for comparisons between the before and after PVR groups and the control group. Results: There were no differences in strain parameters before and after PVR. The GPSmax before PVR was lower than that in the control group (P=0.002). Before and after PVR, GCSs were higher and GLSs were lower than those in the control group (before and after GCSs: P=0.002 for both, before and after GLSs: P<0.0001 and P=0.0003). Conclusions: RV strains from radially reconstructed short-axis cine images revealed impaired myocardial motion after PVR. When compared to the control group, changes in GCS and GLS in TOF patients before and after PVR might be due to RV remodeling.

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

Circulation ◽  
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.

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

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.

Persistent end-diastolic forward flow after pulmonary valve replacement in patients with repaired tetralogy of Fallot

2021 ◽  
Author(s):  
Yuji Tominaga ◽  
Masaki Taira ◽  
Takashi Kido ◽  
Tomomitsu Kanaya ◽  
Kanta Araki ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Valve Replacement ◽  
Right Atrial ◽  
Volume Index ◽  
Forward Flow ◽  
Repaired Tetralogy Of Fallot ◽  
Increased Risk ◽  
The Impact

Abstract OBJECTIVES The clinical significance of persistent end-diastolic forward flow (EDFF) after pulmonary valve replacement (PVR) remains unclear in patients with repaired tetralogy of Fallot. This study aimed to identify the characteristics of these patients and the impact of persistent EDFF on outcomes. METHODS Of 46 consecutive patients who underwent PVR for moderate to severe pulmonary regurgitation between 2003 and 2019, 23 (50%) did not show EDFF before PVR [group (−)]. In the remaining 23 patients with EDFF before PVR, EDFF was diminished after PVR in 13 (28%) [group (+, −)] and persisted in 10 (22%) [group (+, +)]. The following variables were compared between these 3 groups: (i) preoperative right ventricular (RV) and right atrial volumes measured by magnetic resonance imaging, haemodynamic parameters measured by cardiac catheterization and the degree of RV myocardial fibrosis measured by RV biopsy obtained at PVR and (ii) the post-PVR course, development of atrial arrhythmia and need for intervention. RESULTS A high RV end-diastolic pressure, a greater right atrial volume index and a greater RV end-systolic volume index before PVR and a high degree of RV fibrosis were significantly associated with persistent EDFF 1 year after PVR. Persistent EDFF was a significant risk factor for postoperative atrial tachyarrhythmia, and catheter ablation and pacemaker implantation were required more frequently in these patients. CONCLUSIONS Persistent EDFF after PVR could predict a worse prognosis, especially an increased risk of arrhythmia. Close follow-up is required in patients with persistent EDFF for early detection of arrhythmia and prompt reintervention if necessary. Clinical trial registration number Institutional review board of Osaka University Hospital, number 16105

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