SUMMARY Right heart volume data were obtained in 63 patients with tetralogy of Fallot. The patients were divided into three groups: 1) preoperative tetralogy (N=34); 2) post shunt procedure (N= 14); 3A) post repair without outflow patch (N= 10); 3B) post repair with an outflow patch (N=8). In Group 1 right ventricular end-diastolic volume (RVEDV), RV ejection fraction (EF), and RV systolic output (SO) were all mildly depressed. In post shunt patients, RVEDV was normal but RVEF remained depressed. RVEDV and RVSO increased following a shunt procedure, and these variables were larger in patients with a large versus a small shunt. In Group 3A RVEDV, ALTHOUGH TREATMENT for suspected right ventricular (RV) failure is common after tetralogy of Fallot repair, very little information is available on the direct measurement of RV performance in these patients. Such measurements may become increasingly important in the evaluation of current methods of treatment for both the infant and the older child with tetralogy of Fallot. The purpose of this investigation, therefore, was to analyze biplane cineangiocardiograms in patients before and after surgery for tetralogy of Fallot to determine right ventricular end-diastolic and end-systolic volumes, ejection fraction, systolic output, and maximum right atrial volume and to attempt to correlate these findings with clinical course and other pertinent hemodynamic data. MethodsAll patients studied at Vanderbilt Hospital from July 1971 to October 1975 with the diagnosis of tetralogy of Fallot and adequate biplane cineangiocardiograms for analysis were included. Tetralogy of Fallot was defined as the condition in which there is a large ventricular septal defect with equal right and left ventricular peak systolic pressures associated with right ventricular outflow tract obstruction, and bidirectional shunting. There were three basic patient groups.Group 1 consisted of patients prior to any surgical procedure. There were 34 studies performed on 32 patients in this group whose ages ranged from 3 days to 12 years with an average age of 2.1 ± 0.4 yr (mean ± SEM). Sixteen patients were less than one year of age and 24 were less than two years. Arterial oxygen saturation (02 SAT) ranged from 67-98% at rest and averaged 80 ± 2%. Only four patients had arterial 02 SATs at rest . 90%, and all four had a de- 417RVEF, and RVSO were normal. In contrast in patients in Group 3B, RVEDV was increased averaging 177 ± 15% of normal, RVEF was depressed averaging 0.45 ± 0.04, and RVSO was normal. RV size and pump function are abnormal in patients whose operation requires an outflow tract patch and the factors which may contribute to these abnormalities include a higher RV peak pressure, pulmonary incompetence, and a larger noncontractile outflow tract. Longitudinal studies relating these variables to clinical performance and exercise testing will be important in assessment of the importance of these abnormalities.crease in 02 SAT with crying. Hematocrits ranged from 36-73% with an average of 47 ± 2%, tabl...

Left ventricular and left atrial volume, left ventricular ejection fraction, and left ventricular muscle mass were determined preoperatively and postoperatively in 13 patients who underwent surgical closure of ventricular septal defects in the first two years of life. Left ventricular end-diastolic volume and systolic output averaged 255 +/- 19% (+/- SEM) and 240 +/- 19% of normal, respectively, before operation but fell to within normal limits postoperatively. Left ventricular ejection fraction was normal preoperatively (100 +/- 4% of normal) and remained so after correction (106 +/- 3%, NS). Left ventricular mass was mildly elevated at the preoperative catheterization (271 +/- 21%) and decreased significantly following repair (P less than 0.001). However, the postoperative left atrial volume (147 +/- 14%) remained abnormal (P greater than 0.05). These data suggest that when early surgical closure of a ventricular septal defect is necessary because of failure of medical management, good results with regard to postoperative left ventricular size and function can be expected.

volume. These data indicate that substantial augmentation in RV end-diastolic volume does occur in patients with isolated ventricular septal defects and large left-to-right shunts. These data can be explained by the significant diastolic and "isovolumic" shunting from left ventricle to right ventricle which occurs in these patients.Methods Infants and children undergoing cardiac catheterization at Vanderbilt University and having the diagnosis of an isolated ventricular septal defect constitute the study population. Patients with a significant atrial shunt (mixed venous blood to right atrial 02 saturation stepup of >7%), semilunar valvular incompetence, or atrioventricular valvular incompetence were excluded from this study. All data were obtained during diagnostic cardiac catheterization. Patients less than six weeks of age received no premedication, but occasionally were given small doses of morphine (0.05 mg/kg). Patients from six weeks to two years of age were sedated with meperidine, 1 mg/kg, and hydroxyzine, 1 mg/kg i.m., given 30 min before the beginning of the catheterization procedure. Occasionally, additional doses of meperidine of 0.1 to 0.5 mg/kg were required for sedation during the procedure. Patients above two years of age were sedated with Innovar, 0.025 ml/kg, up to a maximum of 1 cc i.m. given 30 min prior to the procedure.

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