Assessment of right ventricular function during exercise with quantitative Doppler tissue imaging in children late after repair of tetralogy of Fallot

Harada, Kenji; Toyono, Manatomo; Yamamoto, Fumio

doi:10.1016/j.echo.2004.04.037

Cited by 72 publications

(77 citation statements)

References 26 publications

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“…Harada et al (36) reported that an insufficient increase in Sm suggests impaired response to exercise of RV in patients with ToF. We found a negative correlation between Sm and METS index (r=-0.25).…”

Section: Discussionsupporting

confidence: 53%

Relationship between ventricular function assessed by tissue Doppler imaging and exercise capacity in patients after repair of tetralogy of Fallot: an observational study

Şaylan¹,

Çevik²,

Tavli³

2012

Anadolu Kardiyol Derg

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Relationship between ventricular function assessed by tissue Doppler imaging and exercise capacity in patients after repair of tetralogy of Fallot: an observational study ABSTRACTObjective: The present study aims to study the relationship between tissue Doppler echocardiography (TDE) indices of right ventricle and exercise capacity in patients after total correction for tetralogy of Fallot (ToF). Methods: This cross-sectional observational study included 20 patients, after undergoing total correction procedure for ToF diagnosed with mild/moderate pulmonary regurgitation and 30 age-matched healthy children. In the postoperative period, patients were invited to hospital for evaluation of the ventricular functions by 2D, M-mode, Doppler (DE) echocardiography and TDE and exercise testing to evaluate the effort capacity. Statistical analysis was performed using Mann-Whitney U and Chi-square tests, and Pearson correlation analysis. Results: Compared with the controls; the mitral annular peak systolic flow velocity (Sm) value was significantly lower, while isovolumic contraction time (IVCT), isovolumic relaxation time (IVRT) and myocardial performance index (MPI) values obtained at the tricuspid and mitral (MV) valves were significantly higher (p<0.05 for all) in patients after ToF repair. There was a negative correlation between the exercise period and the total correction age (r=-0.20, p=0.015) and the same negative correlation existed between the exercise period and METS (r=-0.25, p=0.010). MV IVCT with DE and TDE was found to be correlated with METS (r=-0.45, p=0.04). Left ventricular MPI was found to be correlated with maximum heart rate (r=-0.20, p=0.03). By DE, tricuspid valve deceleration time and Sm peak flow velocity with TDE were significantly correlated with METS (r=-0.30, p=0.04; r=-025, p=0.005, respectively). MPI calculated with TDE was correlated with maximum heart rate (r=-0.15, p<0.01). Conclusion: Even if patients, undergone total correction surgery for ToF were asymptomatic or had minimal clinical symptoms, MPI index assessed by pulse wave TDE and exercise testing may allow early diagnosis of right ventricle dysfunction. Yöntemler: Enine kesitli-gözlemsel çalışmaya, Fallot Tetralojisi tanısı ile tam düzeltme operasyonu uygulanmış, hafif-orta derecede pulmoner regürjitasyonu olan 20 hasta ile kontrol grubu olarak 30 sağlıklı çocuk dahil edildi. Hastalar, ameliyat sonrası dönemde 2D, M mod, Doppler ekokardiyografi ve doku Doppler ekokardiyografi ile ventrikül fonksiyonları, egzersiz testi ile efor kapasiteleri değerlendirilmek üzere hastaneye çağrılmıştır. İstatistiksel analiz Mann-Whitney U ve Ki-kare testi ve Pearson korelasyon analizi ile yapıldı. Bulgular: Kontrol grubu ile karşılaştırıldığında, Fallot tetralojili hasta grubunda mitral annüler pik sistolik akım hız (Sm) değeri belirgin olarak düşük, triküspit ve mitral (MV) kapaktan elde edilen izovolümik relaksasyon zamanı (IVRT), izovolümik kontraksiyon zamanı (IVCT) ve miyokart performans indeksi (MPI) değerleri daha yüksek idi (tümü için p<0....

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Section: Discussionsupporting

confidence: 53%

Relationship between ventricular function assessed by tissue Doppler imaging and exercise capacity in patients after repair of tetralogy of Fallot: an observational study

Şaylan¹,

Çevik²,

Tavli³

2012

Anadolu Kardiyol Derg

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“…We measured the diameter of tricuspid valve and mitral valve annulus at end-diastolic phase in apical four-chamber view. The right ventricle dimension was defined as diameter of TV annulus, and the left ventricle dimension was defined as diameter of MV annulus (13).…”

Section: Methodsmentioning

confidence: 99%

The Role of Mechanical-Electrical Interaction in Ventricular Arrhythmia: Evidence From a Novel Animal Model for Repaired Tetralogy of Fallot

Chiu

Huang

Chang³

et al. 2011

Pediatr Res

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Pulmonary regurgitation and prolonged QRS duration of right bundle branch (RBB) block are common in repaired tetralogy of Fallot (TOF) and increase the risk of sudden death. We sought to establish an animal model to reflect both abnormalities. Twenty-one canines: group I (n ϭ 7) received a surgical right ventricular outflow tract (RVOT) transannular patch plus pulmonary valve destruction; group II (n ϭ 5) received RBB ablation and sham operation; and group III (n ϭ 9) received combined interventions. Serial electrophysiological data were obtained up to 1 y. Procedure mortality was 27.6%. At 1 y, although severe pulmonary regurgitation was documented in most dogs in groups I (71%) and III (100%), progressive RVOT dilatation was noted in group III. RBB block was present in all dogs in groups II and III. However, the increments of QRS duration, QTc, JTc, and QT dispersion progression between 1 mo and 1 y were all greatest in group III. Ventricular arrhythmia events were frequent in group III (median 3.3/mo) but uncommon in groups I and II (median 1/mo). We have created a novel animal model that adequately reflects both the hemodynamic and electrophysiological characteristics of repaired TOF patients and can be applied to examine the risk of ventricular arrhythmias. (Pediatr Res 70: 247-252, 2011) W ith the advances in cardiac interventions, most patients with tetralogy of Fallot (TOF) can survive into adulthood. Long-term follow-up, however, has revealed that these patients are at risk of ventricular arrhythmia and sudden cardiac death (1). Patients with repaired TOF commonly have complete right bundle branch block (RBBB), detected by surface electrocardiography (EKG) with prolonged QRS duration (2). This complication is related to the patch repair of the ventricular septal defect and the right ventricular outflow tract (RVOT) incision to relieve RVOT obstruction. Risk factors for ventricular arrhythmia disclosed in previous studies include hemodynamic factors such as severe pulmonary regurgitation (PR) and increased left ventricle end-diastolic pressure and electrophysiologic factors such as prolonged QRS duration (3,4). The possible mechanism includes a mechanoelectrical interaction that PR could increase right ventricular loading, which further aggravates QRS prolongation (5). Thus, the depolarization and repolarization inhomogeneity and secondary QT prolongation contribute to the development of ventricular arrhythmia. However, the interaction is complex and difficult to elucidate (6).Recently, several animal models have been proposed to simulate the hemodynamic changes in repaired TOF patients by using pulmonary valvotomy or transannular patch (7-11). Although effective in hemodynamic simulation, the importance of electrophysiological factor was seldom addressed. Thus, these models may not adequately represent the whole clinical scenario of repaired TOF. We therefore created a novel animal model in which RVOT transannular patch, PR creation, and RBBB by radiofrequency ablation would all be present to ...

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“…Other studies have suggested the fact that the relative dependence of tissue velocities on ventricular filling conditions in children with atrial septal defect is influenced by right ventricular size and compliance [28]. Tissue velocities were also studied in patients with the tetralogy of Fallot, showing a decrease after surgical correction and being correlated with the degree of pulmonary insufficiency [29]. The right ventricular reserve also proved to be low in these patients during submaximal exercise, being correlated with the decrease of tissue velocities at the tricuspid annulus, with the degree of pulmonary insufficiency, as well as with high atrial natriuretic peptide levels [30].…”

Section: Discussionmentioning

confidence: 99%

Systolic and Diastolic Function in Congestive Heart Failure Pediatric Patients

Butnariu

Zamfir

Iancu

et al. 2016

Romanian Journal of Internal Medicine

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Background and Aims. and Doppler echocardiography are the main methods for the non-invasive evaluation of ventricular function in children. Our study monitored the evaluation of systolic and diastolic function in pediatric patients, using classical echocardiographic parameters and pulsed tissue Doppler parameters, as well as the correlation between these.Methods. The study included 18 healthy children and 9 children diagnosed with congestive heart failure secondary to congenital heart malformations. The parameters of systolic and diastolic function were measured by 2D echocardiography, 2D guided M mode, color and pulsed Doppler, as well as by pulsed tissue Doppler at the level of the mitral and tricuspid annulus.Results. A relaxation alteration pattern or a pseudonormal pattern of E diastolic velocity compared to the A wave was found (E = A; E > A) in the group of subjects with heart failure. E wave deceleration time had significantly increased values in the case of patients with CHF, being correlated with diastolic dysfunction. Left ventricular flow propagation velocity Vp was decreased in patients with heart failure, the E/Vp ratio being maintained relatively constant in subjects with congestive heart failure and healthy subjects, most probably on account of the concomitant change in the E wave. Associations between the severity of systolic dysfunction and the diastolic dysfunction were found in pediatric patients diagnosed with congestive heart failure (Student test, p < 0.05).Conclusions. Tissue Doppler measurements proved to be useful for the evaluation of pediatric patients with altered ventricular geometry secondary to congenital heart disease, systolic-diastolic dysfunction and heart failure.

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Assessment of right ventricular function during exercise with quantitative Doppler tissue imaging in children late after repair of tetralogy of Fallot

Cited by 72 publications

References 26 publications

Relationship between ventricular function assessed by tissue Doppler imaging and exercise capacity in patients after repair of tetralogy of Fallot: an observational study

Relationship between ventricular function assessed by tissue Doppler imaging and exercise capacity in patients after repair of tetralogy of Fallot: an observational study

The Role of Mechanical-Electrical Interaction in Ventricular Arrhythmia: Evidence From a Novel Animal Model for Repaired Tetralogy of Fallot

Systolic and Diastolic Function in Congestive Heart Failure Pediatric Patients

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