Abstract
BackgroundData about the right ventricular (RV) mechanics adaptation to volume overload in patients with repaired tetralogy of Fallot (rToF) are limited. Accordingly, we sought to assess the mechanics of the functional remodeling occurring in the RV of rToF with severe pulmonary regurgitation.MethodsWe used three-dimensional transthoracic echocardiography (3DTE) to obtain RV data sets from 33 rToF patients and 30 age- and sex- matched controls. A 3D mesh model of the RV was generated, and RV global and regional longitudinal (LS) and circumferential (CS) strain components, and the relative contribution of longitudinal (LEF), radial (REF) and anteroposterior (AEF) wall motion to global RV ejection fraction (RVEF) were computed using the ReVISION method.ResultsCorresponding to decreased global RVEF (45 ± 6% vs 55 ± 5%, p < 0.0001), rToF patients demonstrated lower absolute values of LEF (17 ± 4 vs 28 ± 4), REF (20 ± 5 vs 25 ± 4) and AEF (17 ± 5 vs 21 ± 4) than controls (p < 0.01). However, only the relative contribution of LEF to global RVEF (0.39 ± 0.09 vs 0.52 ± 0.05, p < 0.0001) was significantly decreased in rToF, whereas the contribution of REF (0.45 ± 0.08 vs 0.46 ± 0.04, p > 0.05) and AEF (0.38 ± 0.09 vs 0.39 ± 0.04, p > 0.05) to global RVEF was similar to controls. Accordingly, rToF patients showed lower 3D RV global LS (-16.94 ± 2.9 vs -23.22 ± 2.9, p < 0.0001) and CS (-19.79 ± 3.3 vs -22.81 ± 3.5, p < 0.01) than controls. However, looking at the regional RV deformation, the 3D CS was lower in rToF than in controls only in the basal RV free-wall segment (p < 0.01). 3D RV LS was reduced in all RV free-wall segments in rToF (p < 0.0001), but similar to controls in the septum (p > 0.05).Conclusions3DTE allows a quantitative evaluation of the mechanics of global RVEF. In rToF with chronic volume overload, the relative contribution of the longitudinal shortening to global RVEF is affected more than either the radial or the anteroposterior components.
Highlights
Data about the right ventricular (RV) mechanics adaptation to volume overload in patients with repaired tetralogy of Fallot are limited
Left ventricular ejection fraction was lower in repaired tetralogy of Fallot (rToF) patients than in controls, but it was still within the normal range. rToF patients showed significantly larger RV volumes, lower RV ejection fraction (RVEF), tricuspid annular plane systolic excursion (TAPSE), RV free wall S’ velocity, fractional area change (FAC) and higher RV systolic pressure compared with the control group
Corresponding to decreased global RVEF, RV Longitudinal ejection fraction (LEF), Radial ejection fraction (REF) and Anteroposterior ejection fraction (AEF) were significantly lower in rToF patients compared to controls
Summary
Data about the right ventricular (RV) mechanics adaptation to volume overload in patients with repaired tetralogy of Fallot (rToF) are limited. The chronic pulmonary regurgitation and consequent right ventricular (RV) failure in patients after repair of tetralogy of Fallot is an important cause of morbidity. Using the three-dimensional transthoracic echocardiography (3DTE) Lakatos et al demonstrated that the radial and anteroposterior motions directions of the RV have comparable significance to longitudinal shortening in determining global RV function in healthy volunteers [4]. These findings confirmed that standard parameters referring only to longitudinal RV shortening are not sufficient to evaluate the RV function thoroughly
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