Abstract
BackgroundIn patients with repaired tetralogy of Fallot (TOF), a better understanding of the impact of surgical pulmonary valve replacement (PVR) on ventricular mechanics may lead to improved indications and outcomes. Therefore, we used cardiovascular magnetic resonance (CMR) feature tracking analysis to quantify ventricular strain and synchrony in repaired TOF patients before and after PVR.MethodsThirty-six repaired TOF patients (median age 22.4 years) prospectively underwent CMR a mean of 4.5 ± 3.8 months before PVR surgery and 7.3 ± 2.1 months after PVR surgery. Feature tracking analysis on cine steady-state free precession images was used to measure right ventricular (RV) and left ventricular (LV) circumferential strain from short-axis views at basal, mid-ventricular, and apical levels; and longitudinal strain from 4-chamber views. Intraventricular synchrony was quantified using the maximum difference in time-to-peak strain, the standard deviation of the time-to-peak, and cross correlation delay (CCD) metrics; interventricular synchrony was assessed using the CCD metric.ResultsFollowing PVR, RV end-diastolic volume, end-systolic volume, and ejection fraction declined, and LV end-diastolic volume and end-systolic volume both increased with no significant change in the LV ejection fraction. LV global basal and apical circumferential strains, and basal synchrony improved. RV global circumferential and longitudinal strains were unchanged, and there was a varied impact on synchrony across the locations. Interventricular synchrony worsened at the midventricular level but was unchanged at the base and apex, and on 4-chamber views.ConclusionsSurgical PVR in repaired TOF patients led to improved LV global strain and no change in RV global strain. LV and RV synchrony parameters improved or were unchanged, and interventricular synchrony worsened at the midventricular level.
Highlights
In patients with repaired tetralogy of Fallot (TOF), a better understanding of the impact of surgical pulmonary valve replacement (PVR) on ventricular mechanics may lead to improved indications and outcomes
PVR led to virtual elimination of pulmonary regurgitation (PR), and a significant decline in right ventricular (RV) end-diastolic volume (EDV) and end-systolic volume (ESV)
Interventricular synchrony worsened at the midventricular level but was unchanged at the base and apex, and on 4-chamber views
Summary
In patients with repaired tetralogy of Fallot (TOF), a better understanding of the impact of surgical pulmonary valve replacement (PVR) on ventricular mechanics may lead to improved indications and outcomes. Young children undergoing surgical repair of tetralogy of Fallot (TOF) have excellent short-term survival [1]; they experience significant morbidity and mortality related to biventricular dysfunction and arrhythmia in their adult years [2,3,4]. These sequelae are believed to be in part related to chronic pulmonary regurgitation (PR) caused by efforts to relieve pulmonary valve stenosis with the initial repair. Our knowledge of regional ventricular mechanics in this patient group remains rudimentary, in part because robust techniques for its assessment have not been applied
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