Objective-In patients with repaired tetralogy of Fallot, to examine (1) a possible relation between right ventricular enlargement and QRS prolongation, and (2) the eVect of right ventricular enlargement caused by pulmonary regurgitation on the right ventricular ejection fraction, evaluated by three dimensional echocardiography, and global function, evaluated by the myocardial performance index. Design and patients-40 patients with repaired tetralogy were studied. Right ventricular volumes were derived from three dimensional echocardiographic data after this method had been validated by comparison with magnetic resonance imaging in 21 patients. Ejection fraction was calculated from end diastolic and end systolic volumes. The Doppler derived myocardial performance index was measured in all patients. Measured data were correlated with QRS duration. Setting-Tertiary cardiac centre for congenital heart disease. Results-There was good agreement between three dimensional echocardiographic and magnetic resonance assessment of right ventricular volumes and ejection fraction. The z score of the right ventricular end diastolic volume and ejection fraction of all patients was 1.35 and −4.15, respectively. Patients with severe pulmonary regurgitation had a lower right ventricular ejection fraction (p < 0.01) and an increased myocardial performance index (p < 0.01) compared with patients with mild to moderate pulmonary regurgitation. The correlation between ejection fraction and right ventricular end diastolic volume was r = −0.35 (p < 0.05). The mean (SD) QRS duration was 131.89 (25.69) ms, range 80-180 ms. The correlation between QRS duration and right ventricular end diastolic volume was r = 0.6 (p < 0.01). Conclusions-There is a correlation between the right ventricular size obtained by three dimensional echocardiography and QRS duration on the surface ECG, indicating mechanoelectrical interaction. The severity of pulmonary regurgitation has a negative influence on right ventricular ejection fraction and combined systolic and diastolic global function, as assessed by myocardial performance. (Heart 2000;84:416-420) Keywords: tetralogy of Fallot; pulmonary regurgitation; right ventricular enlargement; QRS prolongation In recent years, several studies have emphasised the importance of mechanoelectrical interaction in patients with surgically corrected tetralogy of Fallot. [1][2][3] From these studies we have learnt that a duration of the QRS complex on the surface ECG of more than 180 ms is associated with an increased risk of malignant ventricular dysrhythmias, and that the pulmonary regurgitation which is prevalent after transannular patch repair may predispose to arrhythmias and a poor long term outcome. [4][5][6] Thus far, no attempt has been made to examine possible correlations between the abnormal QRS prolongation, right ventricular function, and right ventricular end diastolic volume. Novel techniques of volumetry such as magnetic resonance imaging 7 and three dimensional echocardiography-which overcome th...

Left ventricular asynchrony may exist in patients after TOF repair with right bundle branch block. This LV asynchrony is associated with a reduction of both regional and global LV function.

The systolic and diastolic function in both ventricles may be altered even after successful corrective surgery of tetralogy of Fallot. The aim of this study was to assess the combined diastolic and systolic function of both ventricles using the Doppler-derived myocardial performance index (MPI) in patients with operated tetralogy of Fallot (TOF). We performed a prospective analysis of 51 patients following corrective surgery of TOF: 21 had a subannular patch, 20 had a homograft implantation at initial operation, and 10 were reoperated with secondary homograft implantation. Patients were examined with Doppler echocardiography, and the MPI, which incorporates ejection and isovolumetric relaxation and contraction times and is an index of global ventricular function, was calculated 10.2 +/- 8.0 (0.89-36) years after surgery. In 86.4% of the examined patients the right ventricular isovolumetric relaxation time was shortened compared to the normal published range or even did not exist (negative value) (p <0.01). The right ventricular MPI was paradoxically below the normal published range in 76.5% of the examined patients. The left ventricle global function was impaired in 23.5% of the examined patients, mainly due to altered systolic function with a prolonged left ventricular isovolumetric contraction time. The z score of the comparison between patients' left ventricular isovolumetric contraction time and the normal published values was 3.03. Patients with severe pulmonary regurgitation also had a prolongation of the isovolumetric relaxation time compared to patients with mild to moderate pulmonary regurgitation. The noncompliant right ventricle may shorten the right ventricular isovolumetric relaxation time, resulting in a paradoxically low right MPI. This may reduce the sensitivity of the index in recognizing patients with right ventricular dysfunction following corrective surgery of TOF. Additional diastolic impairment occurs in patients with right ventricular volume overload.

In contrast to surgery, transcatheter closure of atrial septal defect preserves atrial and right ventricular function. Tissue Doppler derived strain rate can be applied to provide quantitative analysis of regional atrial and ventricular performance.

We aimed to assess the right atrial performance in patients after surgical correction of tetralogy of Fallot, and to clarify the relationship between the pump function of the right atrium and right ventricular systolic function. We included in the study 50 asymptomatic patients following corrective surgery of tetralogy of Fallot, comparing them to 30 normal subjects. Right atrial areas were measured by echocardiography, and the active fractional area of emptying was expressed, in percentages, as the area measured at the onset of atrial contraction, minus the minimal area, divided by the area at the onset of atrial contraction. We used this value to assess the atrial pump function. Right atrial peak strain rates were measured by tissue Doppler imaging. Compared to controls, patients with tetralogy of Fallot had a significantly reduced right atrial active fractional area of emptying (p = 0.005), along with a reduced peak late diastolic strain rate (p = 0.002). Among 20 patients who underwent magnetic resonance tomographic examination, a relatively higher right atrial peak late diastolic strain rate was shown in patients with a right ventricular ejection fraction of less than 50% (p = 0.021). Right atrial performance is reduced in patients after surgical correction of tetralogy of Fallot. When facing right ventricular systolic dysfunction, nonetheless, the right atrial pump function may be relatively enhanced. Tissue Doppler derived strain rate can provide quantitative analysis of regional right atrial performance.