Abstract
Using blood speckle tracking (BST) based on high-frame-rate echocardiography (HFRE), we compared right ventricle (RV) flow dynamics in children with atrial septal defects (ASDs) and repaired tetralogy of Fallot (rTOF). Fifty-seven children with rTOF with severe pulmonary insufficiency (PI) (n = 21), large ASDs (n = 11) and healthy controls (CTL, n = 25) were included. Using a flow phantom, we studied the effects of imaging plane and smoothing parameters on 2-D energy loss (EL). RV diastolic EL was similar in ASD and rTOF, but both were greater than in CTL. Locations of high EL were similar in all groups in systole, occurring in the RV outflow tract and around the tricuspid valve leaflets in early diastole. An additional apical early diastolic area of EL was noted in rTOF, corresponding to colliding tricuspid inflow and PI. The flow phantom revealed that EL varied with imaging plane and smoothing settings but that the EL trend was preserved if kept consistent.
Highlights
Volume loading caused by a large atrial septal defect (ASD) or pulmonary insufficiency (PI) after tetralogy of Fallot repair results in right ventricle (RV) dilation
The 3-D EL curve indicates that most energy loss in the model occurs in diastole, where the filling jet leads to vortex formation with added shearing fluid losses
For the standard 2-D views, both the apical long-axis (ALAX) and apical four-chamber (A4C) views provided a fair representation of the diastolic 3-D EL
Summary
Volume loading caused by a large atrial septal defect (ASD) or pulmonary insufficiency (PI) after tetralogy of Fallot repair (rTOF) results in right ventricle (RV) dilation. The RV is dilated in these two conditions, RV function generally remains preserved in ASD patients whereas progressive RV dysfunction can occur in rTOF patients (van der Ven et al 2019). When RV longitudinal function is studied using strain imaging, RV longitudinal strain is typically reduced in rTOF patients but preserved or even increased in ASD patients (Dragulescu et al 2013). Our group reported that reduction in RV longitudinal function preferentially affects the RV apex in rTOF (Dragulescu et al 2014). Right ventricular function is an important prognostic factor in patients with rTOF, and an early imaging biomarker anticipating.
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call