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Panaioli E, Graziani F, Lillo R, Delogu AB, Grandinetti M, Di Molfetta A, Perri G, Pasquini A, Colizzi C, Lombardo A, Locorotondo G, Amodeo A, Secinaro A, Bruno P, Lanza GA, Massetti M. Early Right Heart Chambers Reverse Remodeling in Patients Operated in Adulthood for Congenital Lesions Associated with Right Heart Chambers Enlargement. World J Pediatr Congenit Heart Surg 2021; 12:747-753. [PMID: 34846962 DOI: 10.1177/21501351211040474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Progressive right heart chambers dilatation is frequent in the adult congenital heart disease (ACHD) population. We evaluated the immediate and mid-term response of right heart chambers to surgery performed in adulthood for lesions associated with right heart chambers enlargement. METHODS Thirty-six adult patients with lesions associated with right heart chambers enlargement submitted to surgery were studied. We collected echocardiographic data of right ventricle (RV) mid-diameter, right atrial volume indexed, RV systolic pressure, and tricuspid annular plane systolic excursion (TAPSE) prior to surgery (T0), at 2 to 5 days (T1), and 3 to 6 months (T2) after surgery. RESULTS At T1, we observed a significant decrease of RV mid-diameter (47.2 ± 8.4 vs. 39.6 ± 7.4 mm, P < .001), right atrial volume indexed (45.6 ± 26.6 vs. 27.2 ± 11 ml/m2, P < .001), and RV systolic pressure (39 ± 14.8 vs. 32.8 ± 11.3 mm Hg, P = .03). At T2, a further significant deviation in the rate of RV diameter (39.6 ± 7.4 vs. 34.5 ± 5.1 mm, P < .001), in RV systolic pressure (32.8 ± 11.3 vs. 25.3 ± 5 mm Hg, P = .03) and TAPSE (13.9 ± 3.2 vs. 15.8 ± 2.6 mm, P < .001) was observed. CONCLUSIONS Positive right heart chambers remodeling occurs as early as in the immediate post-operative period in most ACHD patients operated for lesions associated with right heart chambers enlargement.
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Affiliation(s)
- Elena Panaioli
- 60234Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
| | | | - Rosa Lillo
- 60234Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
| | - Angelica Bibiana Delogu
- Catholic University of the Sacred Heart, Rome, Italy.,18654Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Grandinetti
- 60234Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Gianluigi Perri
- 9342Bambino Gesù Hospital Children Hospital, IRCCS, Rome, Italy
| | - Annalisa Pasquini
- 60234Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Christian Colizzi
- 60234Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonella Lombardo
- 60234Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
| | | | - Antonio Amodeo
- 9342Bambino Gesù Hospital Children Hospital, IRCCS, Rome, Italy
| | | | - Piergiorgio Bruno
- 60234Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gaetano Antonio Lanza
- 60234Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
| | - Massimo Massetti
- 60234Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
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Lee JK, Chikkabyrappa SM, Bhat A, Buddhe S. Echocardiographic assessment of right ventricular volume in repaired tetralogy of Fallot: a novel approach to an older technique. J Echocardiogr 2021; 20:106-114. [PMID: 34850366 DOI: 10.1007/s12574-021-00558-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 09/30/2021] [Accepted: 11/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In repaired tetralogy of Fallot (rTOF), right ventricular (RV) enlargement leads to poor outcomes. However, evaluating the RV has limitations; cardiac magnetic resonance (CMR) and 3D echocardiography have barriers including cost and accessibility. Traditional echocardiography is limited given the complex geometry and anterior location of the RV. We propose a novel echocardiographic evaluation of RV volume using 2 separate views. METHODS This is a retrospective study of rTOF patients with echocardiogram, CMR, and exercise tests. By echocardiogram, we collected RV length in parasternal long axis (PLAX), area in 4-chamber (4C) view, and measurements per standard guidelines. RV end-diastolic and end-systolic volume (RVEDV and RVESV) were calculated as 5/9 (4C area * PLAX length). RESULTS Forty-five patients with 66 sets of CMR, echocardiogram, and exercise tests were included (mean age 13.3 ± 3.2 years). The echocardiographic RVEDV and RVESV showed strong correlation with CMR parameters (r = 0.81 and 0.72; p≤ 0.0001), and moderate correlation with peak oxygen pulse (0.63 and 0.49; p≤0.0001). Guideline measurements had no significant correlation. Echocardiographic RVEDV and RVESV were higher in those requiring subsequent pulmonary valve replacement. Indexed echocardiographic RVEDV of 93 ml/m2 had 92% sensitivity and 50% specificity (area under curve 0.75 (p = 0.001)) in predicting CMR RV/LV EDV ratio > 2, which is an early indicator for pulmonary valve replacement. CONCLUSIONS This novel technique correlates strongly with CMR, better than traditional parameters. While echocardiogram will not replace CMR, this method would be useful in predicting the RV volume, progression of dilation, and timing of CMR.
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Affiliation(s)
- Joan K Lee
- Department of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, 400 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Sathish Mallenahalli Chikkabyrappa
- Department of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, 400 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Aarti Bhat
- Department of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, 400 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Sujatha Buddhe
- Department of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, 400 Sand Point Way NE, Seattle, WA, 98105, USA
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Kavurt AV, Paç FA, Koca S, Mutlu Mıhçıoğlu A, Yiğit H. The evaluation of right ventricular systolic function in patients with repaired Tetralogy of Fallot by conventional echocardiographic methods and speckle tracking echocardiography: Compared with the gold standard cardiac mangenetic resonance. Echocardiography 2019; 36:2251-2258. [PMID: 31755582 DOI: 10.1111/echo.14532] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 10/18/2019] [Accepted: 10/20/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Right ventricular (RV) function is one of the important prognostic factors in patients with repaired Tetralogy of Fallot (TOF). We aimed to assess RV function by conventional echocardiography and two-dimensional speckle tracking echocardiography (2D-STE) in patients with repaired TOF. METHODS Twenty-seven (male 17) adolescents and young adult patients (mean age 22.7 ± 6.7 years) operated on for TOF and age- and gender-matched healthy controls were included. RV systolic function in both groups were evaluated by fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), RV myocardial performance index (RVMPI) and tricuspid annular peak systolic velocity by pulsed tissue Doppler (tricuspid S'), and also RV global longitudinal strain (RV GLS) obtained from STE. These results were compared with RV ejection fraction (RVEF) measured by cardiac magnetic resonance imaging (CMRI) performed within 3 months in patient group. RESULTS Systolic RVGLS values were significantly lower in patients compared to controls (-17.4 ± 3.1% vs -25.6 ± 3%). Among the echocardiographic parameters, RVGLS had the best correlation with RV EF derived from CMRI (r: -.6). By receiver operating characteristics analysis (ROC), an RV GLS cutoff value of -17.4% had 75% sensitivity and 68.4% specificity in identifying RVEF <45% with an area under curve 0.743 (P < .05). The intra- and inter-observer agreement for RV GLS was excellent. CONCLUSION RVGLS is an easy, effective, feasible, and reproducible tool in the evaluation of RV systolic function. So, RVGLS measurement by STE may be one of the routine echocardiographic parameters in the evaluation of RV systolic function in patients with repaired TOF.
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Affiliation(s)
- Ahmet Vedat Kavurt
- Department of Pediatric Cardiology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Feyza Ayşenur Paç
- Department of Pediatric Cardiology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Serhat Koca
- Department of Pediatric Cardiology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Ajda Mutlu Mıhçıoğlu
- Department of Pediatric Cardiology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Hasan Yiğit
- Department of Radiology, Ankara Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Improving the role of echocardiography in studying the right ventricle of repaired tetralogy of Fallot patients: comparison with cardiac magnetic resonance. Int J Cardiovasc Imaging 2017; 34:399-406. [PMID: 28988308 DOI: 10.1007/s10554-017-1249-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
Right ventricular (RV) evaluation represents one of the major clinical tasks in the follow-up of repaired tetralogy of Fallot patients (rToF) with pulmonary valve regurgitation, as both severe RV dilatation and dysfunction are key factors in defining the need of pulmonary valve replacement. The aim of our study was to report the diagnostic accuracy of echocardiography in the identification of rToF patients with severely dilated and/or depressed RV as compared to cardiac magnetic resonance (CMR). Among our patients with rToF, a subgroup of 95 (17.6 ± 6.8 years; 60% male), who underwent right ventricular qualitative and quantitative evaluation with CMR following echocardiographic suspicion of severe dilation/dysfunction, were included in the analysis. When comparing echocardiographic RV functional parameters to CMR findings, we found no association between CMR-ejection fraction (EF) and either tricuspid annulus plane systolic excursion (TAPSe) nor tissue Doppler systolic tricuspid excursion velocity (all p = ns). In contrast RVFAC was strongly associated with CMR-EF (r = 0.44; p < 0.01) as well as to longitudinal components of RV mechanics including tissue Doppler s' (r = 0.40; p < 0.01) and TAPSE (r = 0.36; p < 0.01). When comparing echocardiographic and CMR structural parameters of the RV, we found that CMR RV volume was strongly related to echocardiographic measurements of RV end diastolic area (from the 4 chamber apical view) and with proximal parasternal short axis right ventricle outflow-dimension. Accordingly a regression model was derived from multiple regression analysis, which allows a more accurate estimate of CMR RV volume from echocardiography (r2 = 0.59, p < 0.001). Our study demonstrates a significant, although imperfect, correlation between echocardiographic and CMR RV functional and geometrical parameters. Combining echocardiographic measures of RV inflow and RV outflow, we deliver a simple formula to estimate CMR-RV volume, improving the echocardiographic accuracy in RV volume quantification.
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Toro KD, Soriano BD, Buddhe S. Right ventricular global longitudinal strain in repaired tetralogy of Fallot. Echocardiography 2016; 33:1557-1562. [DOI: 10.1111/echo.13302] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Kamill Del Toro
- Department of Pediatrics; Division of Pediatric Cardiology; Seattle Children's Hospital; Seattle Washington
| | - Brian D. Soriano
- Department of Pediatrics; Division of Pediatric Cardiology; Seattle Children's Hospital; Seattle Washington
| | - Sujatha Buddhe
- Department of Pediatrics; Division of Pediatric Cardiology; Seattle Children's Hospital; Seattle Washington
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