Abstract
Abstract Background and purpose Patients with repaired Tetralogy of Fallot (TOF) develop significant pulmonary regurgitation (PR) as a main sequel in the adulthood, leading to right ventricular (RV) dilatation and dysfunction. Our objective was to evaluate in adult patients with repaired TOF, the differences in portal venous flow pulsatility (PVFP) compared to controls without structural heart disease, and the relationship between PVFP with the severity of PR and tricuspid regurgitation (TR), as well as parameters of right chamber remodeling and inferior vena cava (IVC) dilation. Methods Single center, observational study. Sixty-seven patients with repaired TOF (prosthetic pulmonary valve: n=27) were included. TOF patients were compared with a control group (n=74). PVFP was assessed using maximum (Vmax) and minimum (Vmin) Doppler velocities in portal vein flow: (Vmax-Vmin)/Vmax. Results There were no differences in age and sex between the two groups. A higher PVFP was observed in the group of patients with TOF compared to the control group (0.4 vs 0.22, p < 0.001; Figure 1A). Pulmonary valve intervention in adulthood was non-significantly associated with an increase in PVFP (intervention vs no intervention 0.46 vs 0.37, p=0.1, Figure 1B). Regarding PR severity, we observed that the 33 patients with severe PR showed a trend to higher PVFP values in relation to patients with moderate PI (n=5); 0.37 vs 0.26, p=0.06 (Figure 1C). No relationship was observed between PVFP and the severity of TR: absence of TR (n=9) 0.36, mild TR (n=49) 0.41, moderate TR (n=7) 0.45, severe TR (n=2) 0.43, p=0.84 (Figure 1D). In patients with TOF, PVFP was not correlated with right atrial area (R=0.02), RV end-diastolic area (R=0.23), RV strain (R=0.36), or with IVC dimensions (R=-0.1). Conclusions In this descriptive study, we identified an altered pattern of portal venous flow in patients with repaired TOF compared to subjects without structural heart disease. This increase in PVFP did not show an evident association with right valvular heart disease associated with TOF, nor with other markers of volume overload, suggesting the influence of multiple determining factors and a potential incremental value over standard measurements in these patients.
Published Version
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