Assessment of right and left ventricular function by tissue Doppler echocardiography in patients after biventricular repair of pulmonary atresia with intact ventricular septum

Mi, Yaping; Cheung, Yiu‐fai

doi:10.1016/j.ijcard.2005.06.036

Cited by 19 publications

(13 citation statements)

References 26 publications

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“…We have previously reported on significant impairment of longitudinal RV systolic and diastolic function, as assessed by tissue Doppler-derived strain and strain rate imaging, in these patients. 10 Results of the present study suggest stiffening of the right ventricle and corroborate those of Redington et al 21 Additionally, we have shown that restrictive RV physiology is highly prevalent (81%) in these patients, exceeding the reported 53% prevalence in patients at 15 to 35 years after repair of tetralogy of Fallot (TOF). 22 In postoperative TOF patients, age at repair, 23 placement of a transannular patch, 15,24 and intraoperative myocardial injury with postoperative oxidative stress 25 have variably been incriminated as the cause of restrictive RV physiology.…”

Section: Discussionsupporting

confidence: 91%

“…6 -8 Previous studies have implicated persistent RV diastolic dysfunction despite the achievement of a biventricular repair. 9,10 The hypertrophic myocardium, myocardial fiber disarray, and varying degrees of endocardial fibroelastosis in PAIVS 11 -14 probably provide anatomic substrates for restrictive RV physiology defined on the basis of increased antegrade late diastolic flow in the RV outflow during atrial systole. 15 Little is known, however, Xue-Cue Liang is currently working in the Children's Hospital of Fudan University, Shanghai.…”

Section: Introductionmentioning

confidence: 99%

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Restrictive Right Ventricular Physiology and Right Ventricular Fibrosis as Assessed by Cardiac Magnetic Resonance and Exercise Capacity After Biventricular Repair of Pulmonary Atresia and Intact Ventricular Septum

Liang

Lam

Cheung

et al. 2010

Clinical Cardiology

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Background: The hypertrophic myocardium, myocardial fiber disarray, and endocardial fibroelastosis in pulmonary atresia and intact ventricular septum (PAIVS) may provide anatomic substrates for restrictive filling of the right ventricle. Hypothesis: Restrictive right ventricle (RV) physiology is related to RV fibrosis and exercise capacity in patients after biventricular repair of PAIVS. Methods: A total of 27 patients, age 16.5 ± 5.6 years, were recruited after biventricular repair of PAIVS. Restrictive RV physiology was defined by the presence of antegrade diastolic pulmonary flow and RV fibrosis assessedby late gadolinium enhancement (LGE) cardiac magnetic resonance.Their RV function was compared with that of 27 healthy controls and related to RV LGE score and exercise capacity. Results: Compared with controls, PAIVS patients had lower tricuspid annular systolic and early diastolic velocities, RV global longitudinal systolic strain, systolic strain rate, and early and late diastolic strain rates (all P < 0.05). A total of 22 (81%, 95% confidence interval: 62%-94%) PAIVS patients demonstrated restrictive RV physiology. Compared to those without restrictive RV physiology (n=5), these 22 patients had lower RV global systolic strain, lower RV systolic and early diastolic strain rates, higher RV LGE score, and a greater percent of predicted maximum oxygen consumption (all P < 0.05). Conclusion: Restrictive RV physiology reflects RV diastolic dysfunction and is associated with more severe RV fibrosis but better exercise capacity in patients after biventricular repair of PAIVS. IntroductionThe evolution in management strategy has significantly improved the long-term outcomes of patients with pulmonary atresia and intact ventricular septum (PAIVS). 1 -3 In the presence of a reasonably good-sized right ventricle and the absence of a right ventricular (RV)-dependent coronary circulation, RV decompression could be achieved by outflow reconstruction, 2 -5 surgical pulmonary valvotomy,

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Restrictive Right Ventricular Physiology and Right Ventricular Fibrosis as Assessed by Cardiac Magnetic Resonance and Exercise Capacity After Biventricular Repair of Pulmonary Atresia and Intact Ventricular Septum

Liang

Lam

Cheung

et al. 2010

Clinical Cardiology

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“…This anatomic substrate may contribute to severe obstruction of the left ventricular outflow tract after volume-unloading surgery [23]. Impairment of left ventricular function in patients with PAIVS has been observed after shunt operation [8], bidirectional cavopulmonary shunt, a Fontan operation [11], and even after biventricular repair [12].…”

Section: Discussionmentioning

confidence: 99%

“…Commonly, these patients have a small, hypertrophied right ventricle (RV) with supra-systemic pressure and sinusoidal communication between the RV and the coronary artery [1,2]. Many authors have noticed the possible deleterious effects associated with this situation, i.e., the progression of RV-to-coronary connections and subsequent coronary artery stenosis [3][4][5][6], potential RV 'steal' and coronary ischemia after RV decompression [4,7], impaired left ventricular compliance [8], left ventricular hypertrophy with a prominent subaortic septal bulge [9,10], fibroelastosis of the left ventricle (LV) [10], and an impaired LV function after a Fontan procedure [11] or even after biventricular repair [12]. A surgical trial to prevent these deleterious effects was first described by Waldman and associates [13].…”

Section: Introductionmentioning

confidence: 99%

Exclusion of the non-functioning right ventricle in children with pulmonary atresia and intact ventricular septum☆

Yang¹,

Jun²,

Park³

et al. 2008

European Journal of Cardio-Thoracic Surgery

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Objective A group of patients with pulmonary atresia and intact ventricular septum (PAIVS) have to undergo single ventricle repair. In these patients, the presence of the non-functioning right ventricle (RV) may lead to the aggravation of RV to coronary connections and left ventricular (LV) dysfunction. To prevent these deleterious effects, the RV was excluded surgically. Methods Between December 2000 and February 2006, 10 patients with PAIVS underwent RV exclusion in conjunction with cavo-pulmonary anastomosis (n = 6) or systemic-to-pulmonary artery shunt (n = 4). Median age at surgery was 5 months (range, 0.2-13.8). Median z-value of the tricuspid valve was À4.0 (range, À6.5 to À1.3). None had RV dependent coronary circulation. The tricuspid valve was closed directly or using a patch. Thrombotic materials were inserted into the RV cavity in eight patients. Results There was no mortality. Follow-up was completed in all patients for up to 79.1 months (median, 30.3). Seven patients underwent a Fontan procedure and the other three are waiting. Eight patients showed completely obliterated RV after exclusion. One of the two patients who had residual RV cavity underwent re-exclusion after a Fontan operation. Postoperative echocardiography revealed that LV enddiastolic dimension increased with borderline significance ( p = 0.050), whereas LV end-systolic dimension showed no significant changes. During follow-up, LV showed no evidence of regional ischemia or global dysfunction, and fractional shortening significantly increased compared with the pre-exclusion value ( p = 0.017). Conclusions This study demonstrates that RV exclusion may be performed safely in a selected group of patients with PAIVS. This procedure may have beneficial effects on LV systolic function, by preventing possible ischemia, and on LV diastolic function, by obliterating the non-functioning cavity and improving the geometry of the ventricular septum. #

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“…Among 106 patients with PA-IVS treated at UCLA between 1982 and 2001, 56 achieved either a complete (30) or partial biventricular repair (26). A partial biventricular repair is a biventricular repair and a bidirectional Glenn, partially offloading the right ventricle, with or without an adjustable atrial septal defect.…”

Section: Patient Populationmentioning

confidence: 99%

Risk factors for early death and reoperation following biventricular repair of pulmonary atresia with intact ventricular septum

Odim

Laks

Tung

2006

European Journal of Cardio-Thoracic Surgery

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Excellent survival follows biventricular repair of pulmonary atresia with intact ventricular septum if RVOTO relief is performed in conjunction with initial palliation. Although most patients eventually require reoperation, avoidance of synthetic transannular patches and monocusp pericardial pulmonary valves may reduce the incidence of wound infection and delay need for pulmonary valve replacement.

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Assessment of right and left ventricular function by tissue Doppler echocardiography in patients after biventricular repair of pulmonary atresia with intact ventricular septum

Cited by 19 publications

References 26 publications

Restrictive Right Ventricular Physiology and Right Ventricular Fibrosis as Assessed by Cardiac Magnetic Resonance and Exercise Capacity After Biventricular Repair of Pulmonary Atresia and Intact Ventricular Septum

Restrictive Right Ventricular Physiology and Right Ventricular Fibrosis as Assessed by Cardiac Magnetic Resonance and Exercise Capacity After Biventricular Repair of Pulmonary Atresia and Intact Ventricular Septum

Exclusion of the non-functioning right ventricle in children with pulmonary atresia and intact ventricular septum☆

Risk factors for early death and reoperation following biventricular repair of pulmonary atresia with intact ventricular septum

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