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Van den Eynde J, Derdeyn E, Schuermans A, Shivaram P, Budts W, Danford DA, Kutty S. End-Diastolic Forward Flow and Restrictive Physiology in Repaired Tetralogy of Fallot: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2022; 11:e024036. [PMID: 35301867 PMCID: PMC9075485 DOI: 10.1161/jaha.121.024036] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Pulmonary arterial end‐diastolic forward flow (EDFF) following repaired tetralogy of Fallot has been thought to represent right ventricular (RV) restrictive physiology, but is not fully understood. This systematic review and meta‐analysis sought to clarify its physiological and clinical correlates, and to define a framework for understanding EDFF and RV restrictive physiology. Methods and Results PubMed/MEDLINE, Embase, Scopus, and reference lists of relevant articles were searched for observational studies published before March 2021. Random‐effects meta‐analysis was performed to identify factors associated with EDFF. Forty‐two individual studies published between 1995 and 2021, including a total of 2651 participants (1132 with EDFF; 1519 with no EDFF), met eligibility criteria. The pooled estimated prevalence of EDFF among patients with repaired tetralogy of Fallot was 46.5% (95% CI, 41.6%–51.3%). Among patients with EDFF, the use of a transannular patch was significantly more common, and their stay in the intensive care unit was longer. EDFF was associated with greater RV indexed volumes and mass, as well as smaller E‐wave velocity at the tricuspid valve. Finally, pulmonary regurgitation fraction was greater in patients with EDFF, and moderate to severe pulmonary regurgitation was more common in this population. Conclusions EDFF is associated with dilated, hypertrophied RVs and longstanding pulmonary regurgitation. Although several studies have defined RV restrictive physiology as the presence of EDFF, our study found no clear indicators of poor RV compliance in patients with EDFF, suggesting that EDFF may have multiple causes and might not be the precise equivalent of RV restrictive physiology.
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Affiliation(s)
- Jef Van den Eynde
- Helen B. Taussig Heart Center The Johns Hopkins Hospital and School of Medicine Baltimore MD.,Department of Cardiovascular Diseases University Hospitals Leuven and Department of Cardiovascular SciencesKU Leuven Leuven Belgium
| | - Emilie Derdeyn
- Faculty of Medicine and Health Sciences University of Antwerp Antwerp Belgium
| | - Art Schuermans
- Department of Cardiovascular Diseases University Hospitals Leuven and Department of Cardiovascular SciencesKU Leuven Leuven Belgium.,Division of Cardiovascular Medicine Radcliffe Department of Medicine Oxford Cardiovascular Clinical Research Facility University of Oxford United Kingdom
| | - Pushpa Shivaram
- Division of Pediatric Cardiology Augusta University Augusta GA
| | - Werner Budts
- Department of Cardiovascular Diseases University Hospitals Leuven and Department of Cardiovascular SciencesKU Leuven Leuven Belgium.,Congenital and Structural Cardiology UZ Leuven Leuven Belgium
| | - David A Danford
- Helen B. Taussig Heart Center The Johns Hopkins Hospital and School of Medicine Baltimore MD
| | - Shelby Kutty
- Helen B. Taussig Heart Center The Johns Hopkins Hospital and School of Medicine Baltimore MD
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Zhang J, Li L, Jani V, Cramer JW, Fletcher SE, Cedars AM, Danford DA, Kutty S, Kutty SS. Increased Hepatic Stiffness in Young Adults After Biventricular Repair of Congenital Heart Disease. Ann Thorac Surg 2021; 112:1335-1341. [DOI: 10.1016/j.athoracsur.2020.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 08/02/2020] [Accepted: 08/06/2020] [Indexed: 12/11/2022]
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Munkhammar P, Carlsson M, Arheden H, Pesonen E. Restrictive right ventricular physiology after tetralogy of Fallot repair is associated with fibrosis of the right ventricular outflow tract visualized on cardiac magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 2013; 14:978-85. [PMID: 23364871 DOI: 10.1093/ehjci/jet009] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS To determine whether the restrictive physiology seen in Tetralogy of Fallot (TOF) patients can be explained by fibrosis of the right ventricular (RV) outflow tract. The aetiology for restrictive RV physiology after TOF repair is not known. METHODS AND RESULTS TOF patients (n = 31, 13 girls, 10.2 years ± 2.8) were included 9.2 ± 2.9 years after total correction and examined with cardiac magnetic resonance (CMR) and Doppler echocardiography. Cine, flow, and late gadolinium contrast enhanced (LGE) CMR imaging were performed to quantify RV volumes, pulmonary flow and regurgitation (PR), and fibrosis. Healthy children (n = 12) were investigated with CMR of the pulmonary flow. Forward flow during atrial contraction above mean + 2 SD of healthy subjects was set as a marker of restrictive physiology. Four patients were excluded due to suboptimal LGE-CMR. Fisher's exact test was used to determine the association between restrictive physiology and fibrosis. Sixteen patients showed fibrosis in the right ventricular outflow tract (RVOT) on LGE-CMR and 14 of them showed restrictive physiology on CMR. Of the 11 patients without fibrosis in the RVOT, 1 showed restrictive physiology. The odds ratio for RVOT fibrosis in patients with restrictive RV physiology was 70.0 (CI: 5.6-882.7, P < 0.001). The transannular patch repair did not differ between the groups (P = 0.37). The degree of RVOT fibrosis correlated positively with PR (r(2) = 0.38, P < 0.001) and RV volumes (r(2) = 0.51 for end-diastolic volume and r(2) = 0.47 for end-systolic volume, P < 0.001). CONCLUSION There is a strong association between the restrictive RV physiology detected on CMR and fibrosis of the RVOT in children after TOF repair.
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Affiliation(s)
- Peter Munkhammar
- Department of Pediatric Cardiology, Skåne University Hospital, Lund University, Lund SE-221 85, Sweden
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Maharaj R. Diastolic dysfunction and heart failure with a preserved ejection fraction: Relevance in critical illness and anaesthesia. J Saudi Heart Assoc 2012; 24:99-121. [PMID: 23960679 DOI: 10.1016/j.jsha.2012.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 01/22/2012] [Accepted: 01/23/2012] [Indexed: 01/19/2023] Open
Abstract
Epidemiological and clinical studies suggest that HF with a preserved ejection fraction will become the more common form of HF which clinicians will encounter. The spectrum of diastolic disease extends from the asymptomatic phase to fulminant cardiac failure. These patients are commonly encountered in operating rooms and critical care units. A clearer understanding of the underlying pathophysiology and clinical implications of HF with a preserved ejection fraction is fundamental to directing further research and to evaluate interventions. This review highlights the impact of diastolic dysfunction and HF with a preserved ejection fraction during the perioperative period and during critical illness.
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Affiliation(s)
- R Maharaj
- Department of Intensive Care Medicine, Kings College Hospital, London SE5 9RS, UK
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Silvilairat S, Wongsathikun J, Sittiwangkul R, Pongprot Y, Chattipakorn N. Effects of left ventricular function on the exercise capacity in patients with repaired tetralogy of Fallot. Echocardiography 2011; 28:1019-24. [PMID: 21929568 DOI: 10.1111/j.1540-8175.2011.01499.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Tissue Doppler imaging has been recently used to evaluate ventricular function. Peak oxygen uptake (V•O2peak) has been demonstrated as a predictor for death in adults with repaired tetralogy of Fallot (TOF). The aim of this study was to determine which Doppler parameters correlated with V•O2peak in patients with repaired TOF. METHOD AND RESULTS Doppler echocardiography, tissue Doppler imaging, and exercise test were performed in 30 patients with TOF after surgical repair. In 30 patients with repaired TOF (median age 14 years, range 9-25 years), 11 patients (37%) were female. Seven patients (median age 12 years) had normal left ventricular diastolic function, whereas the rest of the patients were classified as diastolic dysfunction grade II (median age 15 years; n=15) and III and IV (median age 18 years; n=8). The oxygen uptake at anaerobic threshold (V•O2AT) and peak exercise in patients with left ventricular diastolic dysfunction was significantly lower than that in those with normal diastolic function. Also, V•O2AT and V•O2 peak in patients with diastolic dysfunction grade III and IV were significantly lower than that in those with diastolic dysfunction grade II. Left ventricular early diastolic myocardial velocity was most closely correlated to V•O2peak (r=0.51; P=0.005). Peak early ventricular filling velocity to early diastolic myocardial velocity ratio was significantly correlated with V•O2peak (r=-0.50; P=0.006). CONCLUSION Left ventricular diastolic dysfunction is correlated with V•O2peak. Left ventricular diastolic function should be a routine echocardiographic assessment in patients with repaired TOF.
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Affiliation(s)
- Suchaya Silvilairat
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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van der Hulst AE, Westenberg JJM, Kroft LJM, Bax JJ, Blom NA, de Roos A, Roest AAW. Tetralogy of fallot: 3D velocity-encoded MR imaging for evaluation of right ventricular valve flow and diastolic function in patients after correction. Radiology 2010; 256:724-34. [PMID: 20634432 DOI: 10.1148/radiol.10092269] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate three-dimensional (3D) velocity-encoded (VE) magnetic resonance (MR) imaging, as compared with two-dimensional (2D) VE MR imaging, for assessment of pulmonary valve (PV) and tricuspid valve (TV) flow, with planimetry as the reference standard, and to evaluate diastolic function in patients with a corrected tetralogy of Fallot (TOF). MATERIALS AND METHODS Local institutional review board approval was obtained, and patients or their parents gave informed consent. Twenty-five patients with a corrected TOF (12 male, 13 female; mean age, 13.1 years +/- 2.7 [standard deviation]; age range, 8-18 years) and 19 control subjects (12 male, seven female; mean age, 14.1 years +/- 2.4; age range, 8-18 years) underwent planimetric MR imaging, 2D VE MR imaging, and 3D VE MR imaging for TV and PV flow evaluation. For evaluation of diastolic function, PV and TV flow were summated. Data were analyzed by using linear regression analysis, paired and unpaired t testing, and Bland-Altman plots. RESULTS Strong correlations between the 2D VE MR and 3D VE MR measurements of PV flow (for forward flow: r = 0.87, P < .01; for backward flow: r = 0.97, P < .01) were observed. With PV effective flow as a reference, 3D TV effective flow measurements were more accurate than 2D TV effective flow measurements: In patients, the mean 2D TV effective flow versus 2D PV effective flow difference was 17.6 mL +/- 11 (P < .001), and the mean 3D TV effective flow versus 3D PV effective flow difference was -1.2 mL +/- 4.7 (P = .22). Diastolic functional impairment in patients could be detected at 3D VE MR imaging diastolic assessment. CONCLUSION Three-dimensional VE MR imaging is accurate for PV flow assessment and is more accurate than 2D VE MR imaging for TV flow evaluation. Assessment of diastolic function with 3D VE MR imaging can facilitate ongoing research of diastolic dysfunction in patients with a corrected TOF.
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Affiliation(s)
- Annelies E van der Hulst
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, RC, Leiden, The Netherlands
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Pilla CB, Pereira CA, Fin AV, Aquino FV, Botta A, DalleMulle L, Ricachinevsky CP, Nogueira AJ, Lucchese FA, Rohde LE. Health-related quality of life and right ventricular function in the midterm follow-up assessment after tetralogy of fallot repair. Pediatr Cardiol 2008; 29:409-15. [PMID: 18026777 DOI: 10.1007/s00246-007-9145-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Revised: 08/27/2007] [Accepted: 10/25/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Few data are available on quality of life after surgical repair of tetralogy of Fallot (ToF), and on its relationship to right ventricle function. METHODS Patients with at least 1 year of follow-up evaluation after surgery were studied. Right ventricle function was evaluated by the Doppler-derived myocardial performance index (MPI), and health-related quality of life (HRQL) was assessed by the Child Health Questionnaire, Parent Form-50. Findings were compared with those for an age- and sex-matched group of healthy children. RESULTS The study enrolled 35 successfully repaired ToF patients with 4.9 years (range, 3-7 years) of follow-up evaluation after surgery and 36 healthy children. The MPI demonstrated right ventricle dysfunction in patients compared with controls (0.34; range, 0.26-0.49 vs 0.2; range, 0.13-0.27; p < 0.01), although HRQL for the psychosocial domain was similar between patients and healthy children (summary score, 47.9; range, 45-52 vs 47.5; range, 44.5-50; p = 0.17). A trend for poorer physical area results was observed in patients (summary score, 44; range, 31-52 vs 48.5; range, 45.7-51.7; p = 0.06). Neither physical nor psychosocial summary scores for HRQL had any correlation with right ventricle MPI. CONCLUSIONS Right ventricle dysfunction is present in postoperative ToF patients. The psychosocial domain of HRQL is preserved after surgery. A trend for worse results was observed in the physical domain. The right ventricle function is not related to quality of life after surgical repair of ToF.
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Affiliation(s)
- C B Pilla
- Pediatric Cardiology, Intensive Care, and Cardiac Surgery Departments, Hospital da Criança Santo Antônio, Santa Casa de Porto Alegre, Av Independência, 155, 90035-074, Porto Alegre, RS, Brazil.
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Lee JH, Kim YH, Hyun MC, Lee SB. Evaluation of short-term cardiac function by tissue Doppler imaging in pre and postoperative period of congenital heart disease. KOREAN JOURNAL OF PEDIATRICS 2007. [DOI: 10.3345/kjp.2007.50.5.476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jun-Hwa Lee
- Department of Pediatrics, School of Medicine, Sungkyunkwan University, Masan Samsung Hospital, Masan, Korea
| | - Yeo-Hyang Kim
- Department of Pediatrics, School of Medicine, Keimyung University, Korea
| | - Myung-Chul Hyun
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sang-Bum Lee
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
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Grown-up congenital heart disease: The problem of late arrhythmia and ventricular dysfunction. PROGRESS IN PEDIATRIC CARDIOLOGY 2006. [DOI: 10.1016/j.ppedcard.2006.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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van Straten A, Vliegen HW, Hazekamp MG, de Roos A. Right ventricular function late after total repair of tetralogy of Fallot. Eur Radiol 2005; 15:702-7. [PMID: 15726380 DOI: 10.1007/s00330-004-2574-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2004] [Revised: 10/04/2004] [Accepted: 10/12/2004] [Indexed: 11/28/2022]
Abstract
Over the past decades, life expectancy in patients with congenital heart disease has increased dramatically. However, serious complications may develop late after total repair in infancy. These complications are usually the result of longstanding pulmonary regurgitation, which leads to dilatation of the right ventricle and an increased risk for severe arrhythmias. Therefore lifelong follow-up in these patients is required. Cardiac magnetic resonance imaging is the current imaging tool of choice because it offers superior imaging quality and enables accurate quantification of functional parameters such as flow volumes and systolic and diastolic performance.
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Affiliation(s)
- Alexander van Straten
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 Leiden, The Netherlands.
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Dhillon R, Josen M, Henein M, Redington A. Transcatheter closure of atrial septal defect preserves right ventricular function. Heart 2002; 87:461-5. [PMID: 11997422 PMCID: PMC1767091 DOI: 10.1136/heart.87.5.461] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine the effects of atrial septal defects (ASD) and their closure on systolic and diastolic right and left ventricular function; and by comparing surgical closure with transcatheter device closure, to establish differences attributable to cardiopulmonary bypass. DESIGN Cross sectionally guided M mode echocardiographic ventricular long axis function was measured prospectively before and within one week after ASD closure by device in 17 patients and by surgery in 12 patients, and compared with 18 normal subjects. RESULTS All indices of right ventricular function were impaired after surgery: mean total excursion, -1.89 cm (95% confidence interval (CI), -2.18 to -1.59); peak shortening rate, -9.09 cm/s (-10.82 to -7.35); peak lengthening rate, -9.26 cm/s (-11.09 to -7.43). Total excursion and peak lengthening rate were preserved after device closure, at -0.12 cm (-0.28 to 0.05) and 0.01 cm/s (-2.29 to 2.31), respectively. Left ventricular free wall function was unchanged after closure by either method, while all septal measurements were reduced after closure by either method (changes ranging from -3.51 to -0.32; 95% CI ranging from -4.90 to -0.13). CONCLUSIONS Left ventricular free wall function is unaffected by ASD closure, whereas septal function is impaired, irrespective of the method of closure. Right ventricular function, both systolic and diastolic, is impaired by cardiopulmonary bypass but preserved after device closure. These findings support the transcatheter approach to ASD closure in anatomically suitable defects.
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Affiliation(s)
- R Dhillon
- Department of Paediatric Cardiology, Royal Brompton Hospital, London SW3, UK.
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Gatzoulis MA, Elliott JT, Guru V, Siu SC, Warsi MA, Webb GD, Williams WG, Liu P, McLaughlin PR. Right and left ventricular systolic function late after repair of tetralogy of Fallot. Am J Cardiol 2000; 86:1352-7. [PMID: 11113412 DOI: 10.1016/s0002-9149(00)01241-8] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Right ventricular (RV) dysfunction has adverse effects on long-term outcome in patients with repaired tetralogy of Fallot (TOF). We employed serial radionuclide angiography (RNA) to examine RV and left ventricular (LV) systolic function in adults late after TOF repair and its relation to clinical outcome. We reviewed 10-year records of 95 patients (53 men) with TOF followed in our clinic (mean age at repair 12.6 +/- 10.5 years, mean age at last follow-up 37.7 +/- 9.8 years) who underwent at least 2 RNAs between 1987 and 1997. Most patients were well by the end of the study (80% were New York Heart Association class I, 17% were class II, and 3% were in class III). Sixteen patients experienced sustained tachyarrhythmias (8 had atrial; 8 patients had ventricular). One patient died suddenly. Fifteen patients underwent RV outflow reoperations (15 underwent pulmonary valve replacement; 7 had relief of RV outflow obstruction); RV systolic function during exercise in these 15 patients was significantly impaired before and returned to similar levels after surgery, compared with the rest of the patients. Overall, RV and LV function remained stable in the whole group at a mean interval of 5.7 +/- 2.2 years between first and last RNA. This group of closely followed adults with TOF remained well over 10 years with a low incidence of sudden death and stable RV and LV systolic function, despite a relatively large number of RV outflow reoperations. Aggressive intervention for right-sided hemodynamic abnormalities may have contributed to this outcome. Preserved ventricular function may herald a favorable long-term outlook in this group.
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Affiliation(s)
- M A Gatzoulis
- Department of Medicine, University of Toronto Congenital Cardiac Centre for Adults, University Health Network, University of Toronto, Ontario, Canada.
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