Background-Patients after repair of tetralogy of Fallot (ToF) frequently have right ventricular (RV) dysfunction and prolonged QRS duration (QRSd) and thus could be candidates for cardiac resynchronization therapy. We aimed to assess the relationship between QRSd and the timing of RV wall motion, including the RV outflow tract (RVOT), in these patients. Methods and Results-Sixty-seven repaired ToF patients (median age, 34 years; interquartile range, 24 to 43 years) and 35 age-matched control subjects were studied by echocardiography and cardiovascular magnetic resonance (nϭ55 of 67 ToF patients). Time intervals of the RV cardiac cycle were measured from Doppler recordings. Long-axis M-mode recordings were acquired from the right ventricular (RV) free wall and RV outflow tract (RVOT), and the delay in onset of long-axis shortening was measured. ToF patients showed minor abnormalities of the RV cardiac cycle unrelated to QRSd. RV ejection time was prolonged and correspondingly filling time was reduced compared with control subjects (22.3Ϯ2.6 versus 20.0Ϯ2.9 s/min, PϽ0.0001; 29.0Ϯ3.8 versus 32.7Ϯ3.5 s/min, PϽ0.0001). Total isovolumic time was normal in ToF patients (8.7Ϯ4.0 versus 7.4Ϯ2.9 s/min; PϭNS). QRSd correlated with the delay in RV free wall motion (rϭ0.55, PϽ0.0001) and more so with the delay in RVOT shortening (rϭ0.82, PϽ0.0001). QRSd also correlated with measures of RVOT abnormality such as long-axis RVOT excursion and akinetic area length (rϭϪ0. 46, Pϭ0.004; rϭ0.33, Pϭ0.01). Conclusions-QRSd in postoperative ToF patients reflects mainly abnormalities of the RVOT rather than the RV body itself. Thus, prevention and treatment of mechanical asynchrony and malignant arrhythmia should focus on the RV infundibulum. Indications for cardiac resynchronization therapy after ToF repair warrant further investigation.

In the systemic RV as in the normal LV, there was predominant circumferential over longitudinal free wall shortening, opposite from findings in the normal RV. This may represent an adaptive response to the systemic load. Noticeably, however, the systemic RV did not display torsion as found in the normal LV.

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We report two kindreds from northern Norway with 7 and 4 cases of papillary thyroid carcinoma in otherwise healthy, nonirradiated subjects. While histologic features were comparable the patient's age at the time of diagnosis was lower and lymph node metastases were more frequent in familial than in nonfamilial cases of papillary thyroid carcinoma from the same region. We conclude that genetic factors can predispose the patient for development of papillary thyroid carcinoma. The high local incidence may be due to interaction between susceptibility gene(s) and environmental factors.