Right Ventricular Function Impairment in Children After Tetralogy of Fallot Repair

Abstract

To the Editor, We read with interest the article “Noninvasive perioperative evaluation of right ventricular function in children with tetralogy of Fallot” from Ye et al. (1). In our opinion this is an excellent article describing right ventricular (RV) function impairment using tissue Doppler imaging (TDI) before and after surgical repair of tetralogy of Fallot (TOF) in children. We want to highlight that for the first time Ye et al. (1) showed significantly increased matrix metalloproteinase concentrations in these TOF patients. The authors clearly state that TDI parameters, such as tricuspid annular peak systolic velocity (S′), provide useful information about RV function in children with TOF. Recently, Klitsie et al. (2) also found a reduced S′ in patients with transposition of the great arteries and found that RV systolic performance remained significantly impaired at medium-term follow-up of 9 months. In children after open-heart surgery for TOF defect, the S′ values were shown to be decreased and also to worsen continuously over time (3). Ye et al. (1) found that S′ was significantly lower in the TOF patients than in the control group. For the convenience of the readers of Artificial Organs, we would like to mention that a comparison of their S′ data to available normal S′ values and Z scores (4) would have improved the statistical power of their analysis. We want to thank the authors for addressing the need for careful and systematic evaluation of RV function parameters and cardiac biomarkers in TOF patients before and after surgical repair. We hope that with more interesting studies like this from Ye et al. (1), echocardiographic quantification of RV function in patients with RV-dominant heart diseases will become a routine measurement in the follow-up of TOF patients.