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Kim BJ, Thomas JD. Echocardiographic Parameters of the Right Ventricle in Patients With Pulmonary Hypertension: A Review. Korean Circ J 2025; 55:259-274. [PMID: 40097283 PMCID: PMC12046298 DOI: 10.4070/kcj.2024.0313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Revised: 11/18/2024] [Accepted: 12/23/2024] [Indexed: 03/19/2025] Open
Abstract
To diagnose pulmonary hypertension (PH) and assess its severity, accurate measurement of pulmonary artery (PA) pressure is crucial. However, there can be significant discrepancies between echocardiography (Echo) and invasive catheterization. The right ventricle (RV) has a complex structure, and its remodeling in PH is diverse, making it challenging to evaluate RV physiology with a single imaging modality. While right heart catheterization is the gold standard, its practicality in clinical settings is limited. Cardiac magnetic resonance imaging (MRI) is valuable for RV evaluation, with 4-dimensional flow MRI showing promise, yet accessibility remains a concern. Thus, in PH patient management, Echo plays a central role as a practical decision-making tool. This review aims to elucidate Echo parameters in PH patients, highlighting differences in PA systolic pressure measurements, RV-PA coupling, RV remodeling patterns crucial for understanding PH progression, and clinical evidence regarding RV strain. Additionally, it aims to introduce new Echo parameters that help understand RV in PH.
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Affiliation(s)
- Bong-Joon Kim
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
- Division of Cardiology, Center for Heart Valve Disease, Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL, USA
| | - James D Thomas
- Division of Cardiology, Center for Heart Valve Disease, Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL, USA.
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Duarte VE, Yamamura K, Economy KE, Graf JA, Lu M, Assenza GE, Karur GR, Marenco A, Ishikita A, Duncan ME, Geva T, Wald RM, Valente AM. The effects of pregnancy in subjects with repaired tetralogy of Fallot. Am Heart J 2024; 274:95-101. [PMID: 38677503 PMCID: PMC11791649 DOI: 10.1016/j.ahj.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/10/2024] [Accepted: 04/23/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Previous reports reveal inconsistent findings of right ventricular (RV) changes following pregnancy in subjects with repaired tetralogy of Fallot (rTOF). METHODS A two-center, retrospective cohort study which included women with rTOF who completed pregnancy that were matched to nulliparous women with rTOF by age at the time of baseline cardiac magnetic resonance (CMR), RV ejection fraction (RVEF), and indexed RV end-diastolic volume (RVEDVi). Pre-pregnancy and postpartum cardiac magnetic resonance (CMR) were analyzed and compared to sequential CMR of nulliparous subjects with rTOF. RESULTS Thirty-six women with rTOF who completed pregnancy were matched to 72 nulliparous women with rTOF. Over a mean period of 3.1 years for the pregnancy group and 2.7 years for the comparison group, there was no significant change in the RVEDVi, RVEF, RV mass, pulmonary regurgitation severity, left ventricular (LV) volumes, LV ejection fraction (LVEF), or LV mass when comparing the baseline CMR and the follow-up CMR in either of the groups. There was a slight increase in RV indexed end-systolic volume (RVESVi) when comparing the baseline CMR and the follow-up CMR in the pregnancy group (68.93, SD 23.34 ml/m2 at baseline vs. 72.97, SD 25.24 mL/m2 at follow-up, P = .028). Using a mixed effects model for CMR parameters change over time; when adjusted for time between baseline and follow-up CMR there was no significant difference in rate of change between the pregnancy and comparison groups. CONCLUSIONS Most ventricular remodeling parameters measured by CMR did not significantly change in subjects with rTOF who completed pregnancy or in nulliparous subjects with rTOF. In the pregnancy group, RVESVi is larger in those individuals who have undergone pregnancy without a significant change in ventricular function. These patients should be followed longitudinally to determine the long-term ventricular and clinical effects of pregnancy.
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Affiliation(s)
- Valeria E Duarte
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Boston, MA.
| | - Kenichiro Yamamura
- University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Katherine E Economy
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Brigham and Women's Hospital, Boston, MA
| | - Julia A Graf
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Minmin Lu
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Gabriele Egidy Assenza
- Pediatric Cardiology and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gauri R Karur
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Anais Marenco
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Ayako Ishikita
- University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Madeline E Duncan
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Rachel M Wald
- University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Anne Marie Valente
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Boston, MA
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3
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Bertram H, Rickers C, Eicken A, Rüffer A, Diller GP. [Fallot'sche Tetralogie]. Thorac Cardiovasc Surg 2024; 72:S101-S117. [PMID: 39933509 DOI: 10.1055/a-2464-7715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2025]
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Lagerstrand K, Nyström A, Svensson PA, De Lange C, Dangardt F. Accurate quantification of pulmonary perfusion ratio in children with congenital heart disease using partial volume corrected 4D flow cardiac magnetic resonance. Front Pediatr 2024; 12:1339679. [PMID: 38818350 PMCID: PMC11137306 DOI: 10.3389/fped.2024.1339679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
Background In children with congenital heart disease (CHD), lung scintigraphy is the reference standard for evaluation of pulmonary perfusion. 4D flow CMR offers a non-ionizing alternative. Due to the intrinsic limitation in the spatial resolution, however, 4D flow may display clinically unacceptable differences compared to the reference standard. This case study aims to highlight the importance of correcting for such partial volume errors to accurately evaluate pulmonary perfusion in small pulmonary arteries. Methods Children with CHD, mainly those with transposition of the great arteries or tetralogy-of-Fallot, referred to CMR from 2020 to 2022 at our clinic, were retrospectively reviewed; n = 37. All patients had been examined with a free breathing, motion-corrected 4D flow protocol. Comparison in pulmonary perfusion (PPR: relative flow through right and left pulmonary arteries) with scintigraphy were performed both for 4D flow before and after partial volume correction. Results Patients with large pulmonary arteries, 76%, displayed small differences in PPR between modalities (<20%), while patients with arteries of only a few pixels, 24%, displayed differences up to 178%, depending on the relative difference in size between the right and left pulmonary artery. Differences were effectively reduced after partial volume correction (<21%). Conclusion The present report shows that 4D flow is a promising tool to accurately evaluate the pulmonary perfusion in children with CHD, but that partial volume correction is warranted to overcome its limitation in the spatial resolution. Without such correction, lung scintigraphy is still recommended to ensure high diagnostic certainty in children with small pulmonary arteries.
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Affiliation(s)
- Kerstin Lagerstrand
- Department of Medical Physics and Biomedical Engineering, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Nyström
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatric Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pär-Arne Svensson
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatric Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Charlotte De Lange
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatric Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Frida Dangardt
- Children's Heart Center, The Queen Silvia Children's Hospital, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Yoshiura T, Masuda T, Tahara M, Kobayashi Y, Kikuhara Y, Ishibashi T, Nonaka H, Oku T, Sato T, Funama Y. Cardiac computed tomography angiography with and without bolus tracking methods in infants with congenital heart disease. RADIATION PROTECTION DOSIMETRY 2024; 200:251-258. [PMID: 38088430 DOI: 10.1093/rpd/ncad295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 10/12/2023] [Accepted: 11/15/2023] [Indexed: 03/05/2024]
Abstract
The study investigated radiation dose, vascular computed tomography (CT) enhancement and image quality of cardiac computed tomography angiography (CCTA) with and without bolus tracking (BT) methods in infants with congenital heart disease (CHD). The volume CT dose index (CTDIvol) and dose length product (DLP) were recorded for all CT scans, and the effective dose was obtained using a conversion factors. The CT number for the ascending aorta (AO) and pulmonary artery (PA), image noise of muscle tissue and contrast-to-noise ratio (CNR) were measured and calculated. The median values in the groups with and without BT were 2.20 mGy versus 0.44 mGy for CTDIvol, 8.10 mGy·cm versus 6.20 mGy·cm for DLP, and 0.66 mSv versus 0.51 mSv for effective dose (p < 0.001). There were no statistical differences in vascular CT enhancement, image noise, and CNR. CCTA without BT methods can reduce the radiation dose while maintaining vascular CT enhancement and image quality compared to CCTA with BT methods.
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Affiliation(s)
- Takayuki Yoshiura
- Graduate School of Health Sciences, Kumamoto University, 4-24-1 Kuhonji, Kumamoto, 862-0976, Japan
- Department of Medical Technology, Tsuchiya General Hospital, 3-30 Nakajima-cho, Hiroshima, 730-8655, Japan
| | - Takanori Masuda
- Department of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, 288 Matsushima, Kurashiki-City, Okayama, 701-0193, Japan
| | - Masahiro Tahara
- Hiroshima Central Street Children's Clinic, 7-1 Mikawa-cho, Hiroshima, 730-0029, Japan
| | - Yukie Kobayashi
- Department of Medical Technology, Tsuchiya General Hospital, 3-30 Nakajima-cho, Hiroshima, 730-8655, Japan
| | - Yukari Kikuhara
- Department of Medical Technology, Tsuchiya General Hospital, 3-30 Nakajima-cho, Hiroshima, 730-8655, Japan
| | - Toru Ishibashi
- Department of Medical Technology, Tsuchiya General Hospital, 3-30 Nakajima-cho, Hiroshima, 730-8655, Japan
| | - Haruki Nonaka
- Department of Medical Technology, Tsuchiya General Hospital, 3-30 Nakajima-cho, Hiroshima, 730-8655, Japan
| | - Takayuki Oku
- Department of Medical Technology, Tsuchiya General Hospital, 3-30 Nakajima-cho, Hiroshima, 730-8655, Japan
| | - Tomoyasu Sato
- Department of Medical Technology, Tsuchiya General Hospital, 3-30 Nakajima-cho, Hiroshima, 730-8655, Japan
| | - Yoshinori Funama
- Department of Medical Radiation Sciences, Faculty of Life Sciences, Kumamoto University, 4-24-1 Kuhonji, Kumamoto, 862-0976, Japan
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Moscatelli S, Pergola V, Motta R, Fortuni F, Borrelli N, Sabatino J, Leo I, Avesani M, Montanaro C, Surkova E, Mapelli M, Perrone MA, di Salvo G. Multimodality Imaging Assessment of Tetralogy of Fallot: From Diagnosis to Long-Term Follow-Up. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1747. [PMID: 38002838 PMCID: PMC10670209 DOI: 10.3390/children10111747] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/21/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023]
Abstract
Tetralogy of Fallot (TOF) is the most common complex congenital heart disease with long-term survivors, demanding serial monitoring of the possible complications that can be encountered from the diagnosis to long-term follow-up. Cardiovascular imaging is key in the diagnosis and serial assessment of TOF patients, guiding patients' management and providing prognostic information. Thorough knowledge of the pathophysiology and expected sequalae in TOF, as well as the advantages and limitations of different non-invasive imaging modalities that can be used for diagnosis and follow-up, is the key to ensuring optimal management of patients with TOF. The aim of this manuscript is to provide a comprehensive overview of the role of each modality and common protocols used in clinical practice in the assessment of TOF patients.
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Affiliation(s)
- Sara Moscatelli
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
- Institute of Cardiovascular Sciences, University College London, London WC1E 6BT, UK
- Paediatric Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London SW3 5NP, UK
| | - Valeria Pergola
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità pubblica, University Hospital of Padua, 35128 Padua, Italy
| | - Raffaella Motta
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità pubblica, University Hospital of Padua, 35128 Padua, Italy
| | - Federico Fortuni
- Department of Cardiology, San Giovanni Battista Hospital, 06034 Foligno, Italy
- Department of Cardiology, Leiden University Medical Center, 2300 Leiden, The Netherlands
| | - Nunzia Borrelli
- Adult Congenital Heart Disease Unit, A.O. dei Colli, Monaldi Hospital, 80131 Naples, Italy
| | - Jolanda Sabatino
- Experimental and Clinical Medicine Department, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Isabella Leo
- Experimental and Clinical Medicine Department, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Martina Avesani
- Division of Paediatric Cardiology, Department of Women and Children's Health, University Hospital of Padua, 35128 Padua, Italy
| | - Claudia Montanaro
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St. Thomas's NHS Foundation Trust, London SW3 5NP, UK
- CMR Unit, Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London SW3 5NP, UK
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - Elena Surkova
- Department of Echocardiography, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London SW3 5NP, UK
| | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20122 Milan, Italy
| | - Marco Alfonso Perrone
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy
- Division of Cardiology and Cardio Lab, Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Giovanni di Salvo
- Division of Paediatric Cardiology, Department of Women and Children's Health, University Hospital of Padua, 35128 Padua, Italy
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DeZorzi C, Marenco A, Valente AM. Tricuspid Regurgitation in Patients with Tetralogy of Fallot. J Clin Med 2023; 12:jcm12072470. [PMID: 37048554 PMCID: PMC10095308 DOI: 10.3390/jcm12072470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
Tricuspid regurgitation in patients with repaired tetralogy of Fallot is an important finding with a wide spectrum of primary and secondary etiologies. Moderate or severe tricuspid regurgitation is associated with a greater incidence of atrial tachyarrhythmias in these patients. It remains uncertain which patients with repaired tetralogy of Fallot may benefit from a tricuspid valve intervention at the time of pulmonary valve replacement.
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Affiliation(s)
- Christopher DeZorzi
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Anais Marenco
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Anne Marie Valente
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Vollbrecht TM, Luetkens JA. [Cardiac MRI of congenital heart disease : From fetus to adult]. RADIOLOGIE (HEIDELBERG, GERMANY) 2022; 62:933-940. [PMID: 35976404 DOI: 10.1007/s00117-022-01062-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cardiac magnetic resonance imaging (MRI) is an important diagnostic tool for initial diagnostic workup and follow-up of patients with congenital heart disease (CHD) of different age groups. OBJECTIVES This review provides an overview of clinically applied MRI sequences for the assessment of CHD, highlights technical developments, and demonstrates key aspects of reporting in specific heart defects. MATERIALS AND METHODS Presentation of epidemiologic data, summary of studies on MRI sequences and their clinical application, and demonstration of clinical examples. RESULTS The broad spectrum of congenital heart defects requires the use of various sequences, which can be modified depending on patient age or treatment status. Cine imaging can be used to assess cardiac function and volumes, phase contrast flow measurements allow for the assessment of vessel hemodynamics, and various techniques of MR angiography allow visualization of the thoracic vessels with high spatiotemporal resolution. New developments allow high-resolution vascular imaging without the need for contrast agents, assessment of additional hemodynamic parameters, or fetal cardiac MRI. CONCLUSION Cardiac MRI can be employed in children as well as in adults with CHD. By using different sequences and considering the treatment status and surgery-related complications, the vast majority of clinical questions can be answered.
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Affiliation(s)
- Thomas M Vollbrecht
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Deutschland
| | - Julian A Luetkens
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Deutschland.
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Lippmann MR, Maron BA. The Right Ventricle: From Embryologic Development to RV Failure. Curr Heart Fail Rep 2022; 19:325-333. [PMID: 36149589 PMCID: PMC9818027 DOI: 10.1007/s11897-022-00572-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW The right ventricle (RV) and left ventricle (LV) have different developmental origins, which likely plays a role in their chamber-specific response to physiological and pathological stress. RV dysfunction is encountered frequently in patients with congenital heart disease (CHD) and right heart abnormalities emerge from different causes than increased afterload alone as is observed in RV dysfunction due to pulmonary hypertension (PH). In this review, we describe the developmental, structural, and functional differences between ventricles while highlighting emerging therapies for RV dysfunction. RECENT FINDINGS There are new insights into the role of fibrosis, inflammation, myocyte contraction, and mitochondrial dynamics in the pathogenesis of RV dysfunction. We discuss the current state of therapies that may potentially improve RV function in both experimental and clinical trials. A clearer understanding of the differences in molecular alterations in the RV compared to the LV may allow for the development of better therapies that treat RV dysfunction.
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Affiliation(s)
- Matthew R. Lippmann
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, 77 Ave. Louis Pasteur, NRB 0630-N, Boston, MA 02115, USA
| | - Bradley A. Maron
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, 77 Ave. Louis Pasteur, NRB 0630-N, Boston, MA 02115, USA,Department of Cardiology, VA Boston Healthcare System, West Roxbury, MA, USA
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Ke S, Weng K, Chang M, Wu M, Li Y, Chien K, Lin C, Hsieh K, Chang M, Pan J, Peng H. Differential Adaptation of Biventricular Myocardial Kinetic Energy in Patients With Repaired Tetralogy of Fallot Assessed by
MR
Tissue Phase Mapping. J Magn Reson Imaging 2022; 57:1492-1504. [PMID: 36094105 DOI: 10.1002/jmri.28420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The myocardial kinetic energy (KE) and its association with pulmonary regurgitation (PR) have yet to be investigated in repaired tetralogy of Fallot (rTOF) patients. PURPOSE To evaluate the adaptation of myocardial KE in rTOF patients by tissue phase mapping (TPM). STUDY TYPE Prospective. POPULATION A total of 49 rTOF patients (23 ± 5 years old; male = 32), 47 normal controls (22 ± 1 year old; male = 29). FIELD STRENGTH/SEQUENCE 3-T/2D dark-blood three-directional velocity-encoded gradient-echo sequence. ASSESSMENT Left and right ventricle (LV, RV) myocardial KE in radial (KEr ), circumferential (KEø ), longitudinal (KEz ) directions. The proportions of KE in each direction to the sum of all KE (KErøz ): %KEr , %KEø , %KEz . PR fraction. STATISTICAL TEST Student's t test, multivariable regression. Statistical significance: P < 0.05. RESULTS In rTOF group, LV KEz remained normal in systole (P = 0.565) and diastole (P = 0.210), whereas diastolic LV %KEz (62% ± 14% vs. 72% ± 7%) and systolic LV %KEø (9% ± 6% vs. 20% ± 7%) were significantly decreased. The KEr and %KEr of both ventricles significantly increased in the rTOF group (RV in diastole: 6 ± 3 vs. 3 ± 1 μJ and 54% ± 13% vs. 27% ± 7%). The rTOF group exhibited significantly higher RV/LV ratios of %KEr (systole: 1.3 ± 0.3 vs. 1.0 ± 0.3) and %KEø (systole: 1.6 ± 0.8 vs. 1.0 ± 0.3) and significantly lower ratios of %KEz in systole (0.7 ± 0.2 vs. 1.0 ± 0.1) and diastole (0.5 ± 0.2 vs. 0.9 ± 0.1). In multivariable regression analysis, the RV peak systolic KErøz , RV systolic KEz , and LV diastolic %KEø were independently associated with PR fraction in the rTOF group (adjusted R2 = 0.479). DATA CONCLUSION In rTOF patients, the adaptation of the KE proportion occurred earlier than that of the KE amplitude, and the biventricular balance of %KE was disrupted. PR may cause differential KE adaptation in RV and LV. TPM-derived KE may be useful in investigation of myocardial adaptation in rTOF patients. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Shi‐Ying Ke
- Department of Biomedical Engineering and Environmental Sciences National Tsing Hua University Hsinchu Taiwan
| | - Ken‐Pen Weng
- School of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
- Congenital Structural Heart Disease Center, Department of Pediatrics Kaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Meng‐Chu Chang
- Department of Biomedical Engineering and Environmental Sciences National Tsing Hua University Hsinchu Taiwan
| | - Ming‐Ting Wu
- School of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
- Department of Radiology Kaohsiung Veterans General Hospital Kaohsiung Taiwan
- Institute of Clinical Medicine National Yang Ming Chiao Tung University Taipei Taiwan
| | - Yi‐He Li
- Department of Radiology Kaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Kuang‐Jen Chien
- Congenital Structural Heart Disease Center, Department of Pediatrics Kaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Chu‐Chuan Lin
- Congenital Structural Heart Disease Center, Department of Pediatrics Kaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Kai‐Sheng Hsieh
- Department of Pediatrics China Medical University Children's Hospital Taichung Taiwan
| | - Ming‐Hua Chang
- Department of Radiology Kaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Jun‐Yen Pan
- Congenital Structural Heart Disease Center, Department of Pediatrics Kaohsiung Veterans General Hospital Kaohsiung Taiwan
- Department of Cardiovascular Surgery Kaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Hsu‐Hsia Peng
- Department of Biomedical Engineering and Environmental Sciences National Tsing Hua University Hsinchu Taiwan
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Adult Congenital Heart Disease (ACHD). REVISTA MÉDICA CLÍNICA LAS CONDES 2022. [DOI: 10.1016/j.rmclc.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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A geometrical pitfall of Area-Length method; -Is left ventricle volume evaluation of repaired Tetralogy of Fallot by angiocardiography accurate? Heart Vessels 2022; 37:1785-1791. [PMID: 35437662 DOI: 10.1007/s00380-022-02072-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/31/2022] [Indexed: 11/04/2022]
Abstract
Biplane Area-Length (AL) method by left ventriculography (LVG) has been widely adopted as a standard method to estimate left ventricular volume. However, we have experienced difficulties in adopting the value by AL method for the children with Tetralogy of Fallot (TOF) due to the discrepancy among volumetric modalities. This study validated some limitations of AL method, considering the basic principles of its formulation. A single center retrospective cohort study was conducted for 1 year. The confirmed 22 cases with repaired TOF at our hospital were enrolled. The clinical characteristics, some cardiac MRI analyses, and all the cardiac catheterization studies were collected. Angiographic data were compared with historic cohorts of Kawasaki disease without any coronary artery lesions by using AL method. Cardiac MRI analyses of ten TOF patients were additionally available. LVG studies showed that the length of the long axis on anteroposterior view (AP) was not equal to that on lateral view (LT) due to anatomically apical elevation in TOF, followed by a significant difference found in the sagittal lengths of the LV long axis between AP and LT (P = 0.003). Because the difference critically affected the formula depending on biplane AL method, the calculated LVEDV of TOF group appeared overestimated, compared with the control group (TOF vs control group: 119.5% ± 6.3% vs 96.4 ± 3.5% of Normal, P = 0.006). Available cardiac MRI analyses of some patients in TOF group revealed 55% increase of LVEDV by AL method (angiocardiography 116 ± 7.0 vs CMR 75 ± 3.7 ml/m2, P = 0.0025). A pitfall exists when applying biplane AL method to measure LV volume especially for TOF patients, because the long axis on AP view is not always identical to that on LT view.
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13
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Haupt LP, Rebs S, Maurer W, Hübscher D, Tiburcy M, Pabel S, Maus A, Köhne S, Tappu R, Haas J, Li Y, Sasse A, Santos CCX, Dressel R, Wojnowski L, Bunt G, Möbius W, Shah AM, Meder B, Wollnik B, Sossalla S, Hasenfuss G, Streckfuss-Bömeke K. Doxorubicin induces cardiotoxicity in a pluripotent stem cell model of aggressive B cell lymphoma cancer patients. Basic Res Cardiol 2022; 117:13. [PMID: 35260914 PMCID: PMC8904375 DOI: 10.1007/s00395-022-00918-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 01/22/2022] [Accepted: 02/07/2022] [Indexed: 01/31/2023]
Abstract
Cancer therapies with anthracyclines have been shown to induce cardiovascular complications. The aims of this study were to establish an in vitro induced pluripotent stem cell model (iPSC) of anthracycline-induced cardiotoxicity (ACT) from patients with an aggressive form of B-cell lymphoma and to examine whether doxorubicin (DOX)-treated ACT-iPSC cardiomyocytes (CM) can recapitulate the clinical features exhibited by patients, and thus help uncover a DOX-dependent pathomechanism. ACT-iPSC CM generated from individuals with CD20+ B-cell lymphoma who had received high doses of DOX and suffered cardiac dysfunction were studied and compared to control-iPSC CM from cancer survivors without cardiac symptoms. In cellular studies, ACT-iPSC CM were persistently more susceptible to DOX toxicity including augmented disorganized myofilament structure, changed mitochondrial shape, and increased apoptotic events. Consistently, ACT-iPSC CM and cardiac fibroblasts isolated from fibrotic human ACT myocardium exhibited higher DOX-dependent reactive oxygen species. In functional studies, Ca2+ transient amplitude of ACT-iPSC CM was reduced compared to control cells, and diastolic sarcoplasmic reticulum Ca2+ leak was DOX-dependently increased. This could be explained by overactive CaMKIIδ in ACT CM. Together with DOX-dependent augmented proarrhythmic cellular triggers and prolonged action potentials in ACT CM, this suggests a cellular link to arrhythmogenic events and contractile dysfunction especially found in ACT engineered human myocardium. CamKIIδ inhibition prevented proarrhythmic triggers in ACT. In contrast, control CM upregulated SERCA2a expression in a DOX-dependent manner, possibly to avoid heart failure conditions. In conclusion, we developed the first human patient-specific stem cell model of DOX-induced cardiac dysfunction from patients with B-cell lymphoma. Our results suggest that DOX-induced stress resulted in arrhythmogenic events associated with contractile dysfunction and finally in heart failure after persistent stress activation in ACT patients.
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Affiliation(s)
- Luis Peter Haupt
- Clinic for Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Sabine Rebs
- Clinic for Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.,Institute of Pharmacology and Toxicology, Würzburg University, Würzburg, Germany
| | - Wiebke Maurer
- Clinic for Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Daniela Hübscher
- Clinic for Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Malte Tiburcy
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.,Institute of Pharmacology and Toxicology, University Medical Centre Göttingen, Göttingen, Germany
| | - Steffen Pabel
- Department of Internal Medicine 2, Cardiology, University Medical Centre Regensburg, Regensburg, Germany
| | - Andreas Maus
- Clinic for Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.,King's College London, British Heart Foundation Centre of Excellence, London, UK
| | - Steffen Köhne
- Clinic for Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Rewati Tappu
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany.,DZHK (German Centrefor Cardiovascular Research), partner site Heidelberg, Heidelberg, Germany
| | - Jan Haas
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany.,DZHK (German Centrefor Cardiovascular Research), partner site Heidelberg, Heidelberg, Germany
| | - Yun Li
- Institute of Human Genetics, University Hospital Centre Göttingen, Göttingen, Germany
| | - Andre Sasse
- Institute of Cellular and Molecular Immunology, University Medical Centre Göttingen, Göttingen, Germany
| | - Celio C X Santos
- King's College London, British Heart Foundation Centre of Excellence, London, UK
| | - Ralf Dressel
- Clinic for Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.,Institute of Cellular and Molecular Immunology, University Medical Centre Göttingen, Göttingen, Germany
| | - Leszek Wojnowski
- Department of Pharmacology, University Medical Centre Mainz, Mainz, Germany
| | - Gertrude Bunt
- Clinical Optical Microscopy, University Medical Centre Göttingen, Göttingen, Germany
| | - Wiebke Möbius
- Department of Neurogenetics, Electron Microscopy Core Unit, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany.,Cluster of Excellence "Multiscale Bioimaging: From Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, Göttingen, Germany
| | - Ajay M Shah
- King's College London, British Heart Foundation Centre of Excellence, London, UK
| | - Benjamin Meder
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany.,DZHK (German Centrefor Cardiovascular Research), partner site Heidelberg, Heidelberg, Germany
| | - Bernd Wollnik
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.,Institute of Human Genetics, University Hospital Centre Göttingen, Göttingen, Germany
| | - Samuel Sossalla
- Clinic for Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.,Department of Internal Medicine 2, Cardiology, University Medical Centre Regensburg, Regensburg, Germany
| | - Gerd Hasenfuss
- Clinic for Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Katrin Streckfuss-Bömeke
- Clinic for Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany. .,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany. .,Institute of Pharmacology and Toxicology, Würzburg University, Würzburg, Germany.
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14
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Cardiopulmonary Exercise Testing in Repaired Tetralogy of Fallot: Multiparametric Overview and Correlation with Cardiac Magnetic Resonance and Physical Activity Level. J Cardiovasc Dev Dis 2022; 9:jcdd9010026. [PMID: 35050237 PMCID: PMC8778451 DOI: 10.3390/jcdd9010026] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 12/12/2022] Open
Abstract
Patients with repaired Tetralogy of Fallot (rToF) typically report having preserved subjective exercise tolerance. Chronic pulmonary regurgitation (PR) with varying degrees of right ventricular (RV) dilation as assessed by cardiac magnetic resonance imaging (MRI) is prevalent in rToF and may contribute to clinical compromise. Cardiopulmonary exercise testing (CPET) provides an objective assessment of functional capacity, and the International Physical Activity Questionnaire (IPAQ) can provide additional data on physical activity (PA) achieved. Our aim was to assess the association between CPET values, IPAQ measures, and MRI parameters. All rToF patients who had both an MRI and CPET performed within one year between March 2019 and June 2021 were selected. Clinical data were extracted from electronic records (including demographic, surgical history, New York Heart Association (NYHA) functional class, QRS duration, arrhythmia, MRI parameters, and CPET data). PA level, based on the IPAQ, was assessed at the time of CPET. Eighty-four patients (22.8 ± 8.4 years) showed a reduction in exercise capacity (median peak VO2 30 mL/kg/min (range 25–33); median percent predicted peak VO2 68% (range 61–78)). Peak VO2, correlated with biventricular stroke volumes (RVSV: β = 6.11 (95%CI, 2.38 to 9.85), p = 0.002; LVSV: β = 15.69 (95% CI 10.16 to 21.21), p < 0.0001) and LVEDVi (β = 8.74 (95%CI, 0.66 to 16.83), p = 0.04) on multivariate analysis adjusted for age, gender, and PA level. Other parameters which correlated with stroke volumes included oxygen uptake efficiency slope (OUES) (RVSV: β = 6.88 (95%CI, 1.93 to 11.84), p = 0.008; LVSV: β = 17.86 (95% CI 10.31 to 25.42), p < 0.0001) and peak O2 pulse (RVSV: β = 0.03 (95%CI, 0.01 to 0.05), p = 0.007; LVSV: β = 0.08 (95% CI 0.05 to 0.11), p < 0.0001). On multivariate analysis adjusted for age and gender, PA level correlated significantly with peak VO2/kg (β = 0.02, 95% CI 0.003 to 0.04; p = 0.019). We observed a reduction in objective exercise tolerance in rToF patients. Biventricular stroke volumes and LVEDVi were associated with peak VO2 irrespective of RV size. OUES and peak O2 pulse were also associated with biventricular stroke volumes. While PA level was associated with peak VO2, the incremental value of this parameter should be the focus of future studies.
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15
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Zhao X, Hu L, Leng S, Tan RS, Chai P, Bryant JA, Teo LLS, Fortier MV, Yeo TJ, Ouyang RZ, Allen JC, Hughes M, Garg P, Zhang S, van der Geest RJ, Yip JW, Tan TH, Tan JL, Zhong Y, Zhong L. Ventricular flow analysis and its association with exertional capacity in repaired tetralogy of Fallot: 4D flow cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2022; 24:4. [PMID: 34980199 PMCID: PMC8722058 DOI: 10.1186/s12968-021-00832-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/23/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) allows quantification of biventricular blood flow by flow components and kinetic energy (KE) analyses. However, it remains unclear whether 4D flow parameters can predict cardiopulmonary exercise testing (CPET) as a clinical outcome in repaired tetralogy of Fallot (rTOF). Current study aimed to (1) compare 4D flow CMR parameters in rTOF with age- and gender-matched healthy controls, (2) investigate associations of 4D flow parameters with functional and volumetric right ventricular (RV) remodelling markers, and CPET outcome. METHODS Sixty-three rTOF patients (14 paediatric, 49 adult; 30 ± 15 years; 29 M) and 63 age- and gender-matched healthy controls (14 paediatric, 49 adult; 31 ± 15 years) were prospectively recruited at four centers. All underwent cine and 4D flow CMR, and all adults performed standardized CPET same day or within one week of CMR. RV remodelling index was calculated as the ratio of RV to left ventricular (LV) end-diastolic volumes. Four flow components were analyzed: direct flow, retained inflow, delayed ejection flow and residual volume. Additionally, three phasic KE parameters normalized to end-diastolic volume (KEiEDV), were analyzed for both LV and RV: peak systolic, average systolic and peak E-wave. RESULTS In comparisons of rTOF vs. healthy controls, median LV retained inflow (18% vs. 16%, P = 0.005) and median peak E-wave KEiEDV (34.9 µJ/ml vs. 29.2 µJ/ml, P = 0.006) were higher in rTOF; median RV direct flow was lower in rTOF (25% vs. 35%, P < 0.001); median RV delayed ejection flow (21% vs. 17%, P < 0.001) and residual volume (39% vs. 31%, P < 0.001) were both greater in rTOF. RV KEiEDV parameters were all higher in rTOF than healthy controls (all P < 0.001). On multivariate analysis, RV direct flow was an independent predictor of RV function and CPET outcome. RV direct flow and RV peak E-wave KEiEDV were independent predictors of RV remodelling index. CONCLUSIONS In this multi-scanner multicenter 4D flow CMR study, reduced RV direct flow was independently associated with RV dysfunction, remodelling and, to a lesser extent, exercise intolerance in rTOF patients. This supports its utility as an imaging parameter for monitoring disease progression and therapeutic response in rTOF. Clinical Trial Registration https://www.clinicaltrials.gov . Unique identifier: NCT03217240.
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Affiliation(s)
- Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Liwei Hu
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ru-San Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ping Chai
- National University Hospital Singapore, Singapore, Singapore
| | - Jennifer Ann Bryant
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Lynette L S Teo
- National University Hospital Singapore, Singapore, Singapore
| | - Marielle V Fortier
- Duke-NUS Medical School, Singapore, Singapore
- KK Women's and Children's Hospital, Singapore, Singapore
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore
| | - Tee Joo Yeo
- National University Hospital Singapore, Singapore, Singapore
| | - Rong Zhen Ouyang
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | | | - Marina Hughes
- Department of Cardiovascular Medicine, University of East Anglia, Norwich, UK
| | - Pankaj Garg
- Department of Cardiovascular Medicine, University of East Anglia, Norwich, UK
| | - Shuo Zhang
- Philips Healthcare Germany, Hamburg, Germany
| | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - James W Yip
- National University Hospital Singapore, Singapore, Singapore
| | - Teng Hong Tan
- Duke-NUS Medical School, Singapore, Singapore
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Ju Le Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Yumin Zhong
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
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16
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Srinivasan R, Faerber JA, DeCost G, Zhang X, DiLorenzo M, Goldmuntz E, Fogel M, Mercer-Rosa L. Right Ventricular Strain Is Associated With Increased Length of Stay After Tetralogy of Fallot Repair. J Cardiovasc Imaging 2022; 30:50-58. [PMID: 35086170 PMCID: PMC8792718 DOI: 10.4250/jcvi.2021.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Little is known regarding right ventricular (RV) remodeling immediately after Tetralogy of Fallot (TOF) repair. We sought to describe myocardial deformation by cardiac magnetic resonance imaging (CMR) after TOF repair and investigate associations between these parameters and early post-operative outcomes. METHODS Fifteen infants underwent CMR without sedation as part of a prospective pilot study after undergoing complete TOF repair, prior to hospital discharge. RV deformation (strain) was measured using tissue tracking, in addition to RV ejection fraction (EF), volumes, and pulmonary regurgitant fraction. Pearson correlation coefficients were used to determine associations between both strain and CMR measures/clinical outcomes. RESULTS Most patients were male (11/15, 73%), with median age at TOF repair 53 days (interquartile range, 13,131). Most patients had pulmonary stenosis (vs. atresia) (11/15, 73%) and 7 (47%) received a transannular patch as part of their repair. RV function was overall preserved with mean RV EF of 62% (standard deviation [SD], 9.8). Peak radial and longitudinal strain were overall diminished (mean ± SD, 33.80 ± 18.30% and −15.50 ± 6.40%, respectively). Longer hospital length of stay after TOF repair was associated with worse RV peak radial ventricular strain (correlation coefficient (r), −0.54; p = 0.04). Greater pulmonary regurgitant fraction was associated with shorter time to peak radial RV strain (r = −0.55, p = 0.03). CONCLUSIONS In this small study, our findings suggest presence of early decrease in RV strain after TOF repair and its association with hospital stay when changes in EF and RV size are not yet apparent.
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Affiliation(s)
- Ranjini Srinivasan
- Division of Pediatric Cardiology, Hassenfeld Children's Hospital, New York University Grossman School of Medicine, New York, NY, USA
| | - Jennifer A. Faerber
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Grace DeCost
- School of Public Health, Brown University, Providence, RI, USA
| | - Xuemei Zhang
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michael DiLorenzo
- Division of Cardiology, Morgan Stanley Children's Hospital of New York, Columbia University, New York, NY, USA
| | - Elizabeth Goldmuntz
- Division of Cardiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Mark Fogel
- Division of Cardiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Laura Mercer-Rosa
- Division of Cardiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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17
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Dorobantu DM, Sharabiani MTA, Taliotis D, Parry AJ, Tulloh RMR, Bentham JR, Caputo M, van Doorn C, Stoica SC. Age over 35 years is associated with increased mortality after pulmonary valve replacement in repaired tetralogy of Fallot: results from the UK National Congenital Heart Disease Audit database. Eur J Cardiothorac Surg 2021; 58:825-831. [PMID: 32187367 PMCID: PMC7890931 DOI: 10.1093/ejcts/ezaa069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/01/2020] [Accepted: 02/05/2020] [Indexed: 01/29/2023] Open
Affiliation(s)
- Dan M Dorobantu
- School of Sport and Health Sciences, University of Exeter, Exeter, UK.,Bristol Medical School, University of Bristol, Bristol, UK.,Department of Cardiology, "Prof. C.C. Iliescu" Institute of Cardiovascular Diseases, Bucharest, Romania
| | - Mansour T A Sharabiani
- Department of Primary Care & Public Health, School of Public Health, Imperial College of London, London, UK
| | - Demetris Taliotis
- Departments of Cardiology and Cardiac Surgery, The Heart Institute and Royal Hospital for Children, Bristol, UK
| | - Andrew J Parry
- Departments of Cardiology and Cardiac Surgery, The Heart Institute and Royal Hospital for Children, Bristol, UK
| | - Robert M R Tulloh
- Bristol Medical School, University of Bristol, Bristol, UK.,Departments of Cardiology and Cardiac Surgery, The Heart Institute and Royal Hospital for Children, Bristol, UK
| | - James R Bentham
- Departments of Cardiology and Cardiac Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Massimo Caputo
- Bristol Medical School, University of Bristol, Bristol, UK.,Departments of Cardiology and Cardiac Surgery, The Heart Institute and Royal Hospital for Children, Bristol, UK
| | - Carin van Doorn
- Departments of Cardiology and Cardiac Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Serban C Stoica
- Bristol Medical School, University of Bristol, Bristol, UK.,Departments of Cardiology and Cardiac Surgery, The Heart Institute and Royal Hospital for Children, Bristol, UK
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18
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Chávez-Saldívar S, Mego JC, Tauma-Arrué A, Coronado J, Luis-Ybáñez O, Bravo-Jaimes K. [The adult with tetralogy of fallot: what the clinical cardiologist needs to know]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2021; 2:121-129. [PMID: 38274563 PMCID: PMC10809779 DOI: 10.47487/apcyccv.v2i2.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/26/2021] [Indexed: 01/27/2024]
Abstract
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. After more than seven decades of the first palliative surgery, TOF prognosis has changed dramatically. The prevalence of TOF is approximately 3 per 10 000 births, representing 7 to 10% of congenital heart disease. With a higher survival into adulthood, the clinical cardiologist faces challenges in the management of this population, from severe pulmonary regurgitation to heart failure and ventricular arrhythmias. Its prevalence is approximately 3 per 10 000 live births, representing 7 to 10% of congenital heart disease. This review will describe the most relevant aspects of the care of adult patients with this disease.
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Affiliation(s)
- Samantha Chávez-Saldívar
- Facultad de Medicina San Fernando. Universidad Nacional Mayor de San Marcos. Lima, Perú.Universidad Nacional Mayor de San MarcosFacultad de Medicina San FernandoUniversidad Nacional Mayor de San MarcosLimaPeru
- Sociedad Científica de San Fernando. Lima, Perú.Sociedad Científica de San FernandoLimaPerú
| | - Juan Carlos Mego
- Facultad de Medicina San Fernando. Universidad Nacional Mayor de San Marcos. Lima, Perú.Universidad Nacional Mayor de San MarcosFacultad de Medicina San FernandoUniversidad Nacional Mayor de San MarcosLimaPeru
- Sociedad Científica de San Fernando. Lima, Perú.Sociedad Científica de San FernandoLimaPerú
| | - Astrid Tauma-Arrué
- Facultad de Medicina San Fernando. Universidad Nacional Mayor de San Marcos. Lima, Perú.Universidad Nacional Mayor de San MarcosFacultad de Medicina San FernandoUniversidad Nacional Mayor de San MarcosLimaPeru
- Sociedad Científica de San Fernando. Lima, Perú.Sociedad Científica de San FernandoLimaPerú
| | - Joel Coronado
- Facultad de Medicina San Fernando. Universidad Nacional Mayor de San Marcos. Lima, Perú.Universidad Nacional Mayor de San MarcosFacultad de Medicina San FernandoUniversidad Nacional Mayor de San MarcosLimaPeru
- Sociedad Científica de San Fernando. Lima, Perú.Sociedad Científica de San FernandoLimaPerú
| | - Odalis Luis-Ybáñez
- Facultad de Medicina San Fernando. Universidad Nacional Mayor de San Marcos. Lima, Perú.Universidad Nacional Mayor de San MarcosFacultad de Medicina San FernandoUniversidad Nacional Mayor de San MarcosLimaPeru
- Sociedad Científica de San Fernando. Lima, Perú.Sociedad Científica de San FernandoLimaPerú
| | - Katia Bravo-Jaimes
- Ahmanson/UCLA Adult Congenital Heart Disease Center. University of California. Los Angeles, Estados Unidos.University of CaliforniaAhmanson/UCLA Adult Congenital Heart Disease CenterUniversity of CaliforniaLos AngelesUSA
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19
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Siripornpitak S, Goo HW. CT and MRI for Repaired Complex Adult Congenital Heart Diseases. Korean J Radiol 2020; 22:308-323. [PMID: 33289363 PMCID: PMC7909854 DOI: 10.3348/kjr.2020.0895] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/21/2020] [Accepted: 09/01/2020] [Indexed: 12/30/2022] Open
Abstract
An increasing number of adult congenital heart disease (ACHD) patients continue to require life-long diagnostic imaging surveillance using cardiac CT and MRI. These patients typically exhibit a large spectrum of unique anatomical and functional changes resulting from either single- or multi-stage palliation and surgical correction. Radiologists involved in the diagnostic task of monitoring treatment effects and detecting potential complications should be familiar with common cardiac CT and MRI findings observed in patients with repaired complex ACHD. This review article highlights the contemporary role of CT and MRI in three commonly encountered repaired ACHD: repaired tetralogy of Fallot, transposition of the great arteries after arterial switch operation, and functional single ventricle after Fontan operation.
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Affiliation(s)
- Suvipaporn Siripornpitak
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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20
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Left ventricular strain and fibrosis in adults with repaired tetralogy of Fallot: A case-control study. Int J Cardiol 2020; 323:34-39. [PMID: 32882293 DOI: 10.1016/j.ijcard.2020.08.092] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/26/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Left ventricular (LV) systolic dysfunction and myocardial fibrosis have prognostic implications in repaired tetralogy of Fallot (rTOF), but their relationship with myocardial strain is not well understood. We evaluated systolic strain and fibrosis (extracellular volume fraction, ECV) of the left ventricle (LV) using feature tracking with magnetic resonance and determine their association with each other and clinical outcome. METHOD Adults with rTOF and age-matched controls underwent CMR to measure LV-ECV. Feature-tracking was used to quantify radial, circumferential, and longitudinal strain in both 2 and 3 dimensions. Clinical events (death, arrhythmia and heart-failure hospitalization) were obtained through chart review. Associations between strain, ECV and clinical events were explored. RESULTS 48 rTOF subjects (age 40.5 ± 14.3, 42% female) and 20 healthy controls were included. Both LV 2D and 3D global circumferential strain (GCS) and global longitudinal strain (GLS) were lower in rTOF subjects (p ≤0.01 for all). There was no association between strain and LV-ECV. Strain parameters correlated with ventricular volumes and function. After a median follow-up of 8.5 years (range 1-10.9 years) there were 5 deaths, 6 hospitalizations and 9 new arrhythmias. By multivariate Cox-regression, GLS was an independent predictor of both hospitalization and death, whereas LV-ECV was an independent predictor of arrhythmia. CONCLUSION While both LV strain abnormalities and fibrosis are present in rTOF, they are associated with different types of clinical outcome, and not to each other. The findings suggest that these measures reflect different long-term adverse adaptations to abnormal hemodynamics.
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Shmukler A, Haramati A, Haramati LB. Overview of Common Surgical Procedures in CHD. Semin Roentgenol 2020; 55:264-278. [PMID: 32859343 DOI: 10.1053/j.ro.2020.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Anna Shmukler
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY..
| | - Adina Haramati
- Department of Radiology, Northwell Health, Manhasset, NY
| | - Linda B Haramati
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.; Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
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Raptis DA, Bhalla S. Current Status of Cardiac CT in Adult Congenital Heart Disease. Semin Roentgenol 2020; 55:230-240. [PMID: 32859340 DOI: 10.1053/j.ro.2020.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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23
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Joshi A, Ghadimi Mahani M, Dorfman A, Balasubramanian S. Cardiac MR Evaluation of Repaired Tetralogy of Fallot. Semin Roentgenol 2020; 55:290-300. [PMID: 32859345 DOI: 10.1053/j.ro.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Aparna Joshi
- Department of Radiology, Section of Pediatric Radiology, Michigan Medicine, Ann Arbor, MI.
| | - Maryam Ghadimi Mahani
- Department of Radiology, Section of Pediatric Radiology and Division of Cardiothoracic Radiology, Michigan Medicine, Ann Arbor, MI
| | - Adam Dorfman
- Department of Pediatrics, Division of Pediatric Cardiology, Michigan Medicine, Ann Arbor, MI
| | - Sowmya Balasubramanian
- Department of Pediatrics, Division of Pediatric Cardiology, Michigan Medicine, Ann Arbor, MI
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Tran CT, Halicek M, Dormer JD, Tandon A, Hussain T, Fei B. Fully automated segmentation of the right ventricle in patients with repaired Tetralogy of Fallot using U-Net. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2020; 11317. [PMID: 32476706 DOI: 10.1117/12.2549052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Cardiac magnetic resonance (CMR) imaging is considered the standard imaging modality for volumetric analysis of the right ventricle (RV), an especially important practice in the evaluation of heart structure and function in patients with repaired Tetralogy of Fallot (rTOF). In clinical practice, however, this requires time-consuming manual delineation of the RV endocardium in multiple 2-dimensional (2D) slices at multiple phases of the cardiac cycle. In this work, we employed a U-Net based 2D convolutional neural network (CNN) classifier in the fully automatic segmentation of the RV blood pool. Our dataset was comprised of 5,729 short-axis cine CMR slices taken from 100 individuals with rTOF. Training of our CNN model was performed on images from 50 individuals while validation was performed on images from 10 individuals. Segmentation results were evaluated by Dice similarity coefficient (DSC) and Hausdorff distance (HD). Use of the CNN model on our testing group of 40 individuals yielded a median DSC of 90% and a median 95th percentile HD of 5.1 mm, demonstrating good performance in these metrics when compared to literature results. Our preliminary results suggest that our deep learning-based method can be effective in automating RV segmentation.
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Affiliation(s)
- Christopher T Tran
- University of Texas at Dallas, Department of Bioengineering, Richardson, TX, USA
| | - Martin Halicek
- University of Texas at Dallas, Department of Bioengineering, Richardson, TX, USA.,Georgia Inst. of Tech. and Emory Univ., Dept. of Biomedical Engineering, Atlanta, GA
| | - James D Dormer
- Georgia Inst. of Tech. and Emory Univ., Dept. of Biomedical Engineering, Atlanta, GA
| | - Animesh Tandon
- Dept. of Radiology, Univ. of Texas Southwestern Medical Center, Dallas, TX.,Department of Pediatrics, Univ. of Texas Southwestern Medical Center, Dallas, TX
| | - Tarique Hussain
- Dept. of Radiology, Univ. of Texas Southwestern Medical Center, Dallas, TX.,Department of Pediatrics, Univ. of Texas Southwestern Medical Center, Dallas, TX
| | - Baowei Fei
- University of Texas at Dallas, Department of Bioengineering, Richardson, TX, USA.,Advanced Imaging Research Center, Univ. of Texas Southwestern Medical Center, Dallas, TX.,Dept. of Radiology, Univ. of Texas Southwestern Medical Center, Dallas, TX
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Abstract
Approximately 50 million adults worldwide have known congenital heart disease (CHD). Among the most common types of CHD defects in adults are atrial septal defects and ventricular septal defects followed by complex congenital heart lesions such as tetralogy of Fallot. Adults with CHDs are more likely to have hypertension, cerebral vascular disease, diabetes and chronic kidney disease than age-matched controls without CHD. Moreover, by the age of 50, adults with CHD are at a greater than 10% risk of experiencing cardiac dysrhythmias and approximately 4% experience sudden death. Consequently, adults with CHD require healthcare that is two- to four-times greater than adults without CHD. This paper discusses the diagnosis and treatment of adults with atrial septal defects, ventricular septal defects and tetralogy of Fallot.
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Affiliation(s)
- Robert J Henning
- School of Public Health, University of South Florida, Tampa, FL 33612, USA
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27
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Bissell MM. Editorial for "Neopulmonary Outflow Tract Obstruction Assessment by 4D Flow Magnetic Resonance Imaging in Adults With Transposition of the Great Arteries After Arterial Switch Operation". J Magn Reson Imaging 2020; 51:1706-1707. [PMID: 32034825 DOI: 10.1002/jmri.27077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/17/2020] [Indexed: 11/07/2022] Open
Affiliation(s)
- Malenka M Bissell
- Department of Biomedical Imaging Science, Leeds Institute to Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2020; 139:e698-e800. [PMID: 30586767 DOI: 10.1161/cir.0000000000000603] [Citation(s) in RCA: 276] [Impact Index Per Article: 55.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Karen K Stout
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Curt J Daniels
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Jamil A Aboulhosn
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Biykem Bozkurt
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Craig S Broberg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Jack M Colman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Stephen R Crumb
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Joseph A Dearani
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Stephanie Fuller
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Michelle Gurvitz
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Paul Khairy
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Michael J Landzberg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Arwa Saidi
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Anne Marie Valente
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - George F Van Hare
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
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Abnormal left ventricular flow organization following repair of tetralogy of Fallot. J Thorac Cardiovasc Surg 2019; 160:1008-1015. [PMID: 31924354 DOI: 10.1016/j.jtcvs.2019.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/13/2019] [Accepted: 11/01/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Left ventricular intracavitary flow (LVICF) characteristics reflect diastolic function. Right ventricular (RV) volume overload due to pulmonary regurgitation (PR) adversely impacts interventricular interactions and left ventricular (LV) function. This aimed to determine whether patients with PR and mild to moderate RV dilation after repair of tetralogy of Fallot (TOF) repair have abnormal LVICF, and to determine whether RV dilation and biventricular function correlate with LVICF abnormalities. METHODS Patients with repaired TOF with PR (n = 11) and controls (n = 11) underwent LVICF analysis. LV end-diastolic volume was partitioned into 4 flow components: direct flow, retained inflow, delayed ejection flow, and residual volume. Flow components were correlated with indexed biventricular size, function, and LV strain. RESULTS The TOF patients had reduced direct flow (35% vs 25%; P = .004) and increased residual volume (15% vs 24%; P = .026) compared with controls. Retained inflow and delayed ejection flow did not differ. Reduced direct flow correlated with increased RV end-diastolic volume index (R = 0.44; P = .042), RV end-systolic volume index (R = -0.46; P = .032), reduced RV ejection fraction (R = 0.45; P = .036), and reduced LV circumferential strain (R = 0.52; P = .014). Increased residual volume correlated with increased RV end-systolic volume index (R = 0.52; P = .013), reduced LV ejection fraction (R = -0.54; P = .010), and reduced LV circumferential strain (R = -0.44; P = .040). CONCLUSIONS Patients with repaired TOF with mild to moderate RV dilation have abnormal LV diastolic direct flow and increased recirculating residual volume. These changes correlate with the degree of RV dilation and impaired LV function.
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Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018; 73:e81-e192. [PMID: 30121239 DOI: 10.1016/j.jacc.2018.08.1029] [Citation(s) in RCA: 586] [Impact Index Per Article: 83.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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