CMR parameters and CMR-FT in repaired tetralogy of Fallot

Abstract

Background Repaired tetralogy of Fallot patients develops postoperative complications that are in need for follow-up and re-intervention in some circumstances. CMR myocardial feature tracking is a novel method that allows quantification of bi-atrial and bi-ventricular mechanics of deformation. So our aim is to assess the added value of cardiac magnetic resonance imaging and its advanced feature tracking analysis in evaluation of repaired tetralogy of Fallot patients. Results CMR was done with feature tracking post-processing analysis for 56 patients with repaired tetralogy of Fallot and 56 healthy volunteers. The commonest postoperative complications in patients with repaired tetralogy of Fallot are in the following order: pulmonary regurgitation with subsequent right ventricular dilatation and tricuspid regurgitation followed by pulmonary stenosis, right ventricular dysfunction, right ventricular outflow tract dilatation, left ventricular dysfunction, aortic and mitral regurgitation and residual ventricular septal defect. All right ventricular volumes were found to be significantly increased compared to those of the healthy volunteers (p value < 0.001) also left ventricular end-diastolic and end-systolic volumes indexed were found to be increased in those patients compared to healthy volunteers (p value < 0.001). Right and left ventricular function were significantly lower in those patients compared to controls. Bi-ventricular CMR-FT indices and right atrial global longitudinal strain were found to be significantly lower in patients with repaired tetralogy of Fallot compared to controls. Right atrium global longitudinal strain was found to be significantly correlated with right ventricular global longitudinal strain and did not correlate with right ventricular ejection fraction and end-diastolic volume indexed; p value < 0.001, 0.109 and 0.565, respectively. Right ventricular global circumferential strain was found to be significantly increased in patients with right ventricular outflow tract obstruction compared to those without obstruction (− 16.26 ± 4.27% vs. − 12.2 ± 3.78%, respectively). Pulmonary regurgitant volume indexed was found to be significantly related to right ventricle longitudinal strain (p value 0.027). Conclusion Biventricular volumetric measures are increased in patients with repaired tetralogy of Fallot compared to controls; however, feature tracking parameters for both ventricles and right atrium are lower in those patients compared to controls.

The Role of Cardiac MRI in Functional and Structural Assessment of The Right Ventricle in Patients with Repaired Fallot Tetralogy

“…The study of Attalla et al (11) showed less than one-third of patients 16 out of 56 are associated with branch stenosis LPA and/or RPA (representing 28.5% from total patients), in which 12 patients had LPA branch stenosis and 12 had RPA branch stenosis and 8 of them had both branch stenosis. Unlike the present study results that showed more than half of the patients 19 out of 30 are associated with branch pulmonary stenosis (representing 63.3% from total patients) as 9 patients had LPA stenosis (30%), and 10 patients (33.3%) had RPA stenosis.…”

“…Regarding valvular regurgitation, the study of Attalla et al (11) showed the majority of patients 54 out of 56 patients showed pulmonary regurgitation (representing 96.4%). Similar to the present study, where the majority of patients 29 out of 30 (96.6%) had MPA regurgitation.…”

“…Regarding ventricular function, the study of Attalla et al (11) showed more than one-third of the patients 20 out of 56 had RV dysfunction (representing 35.7%). Regarding the present study less than onethird of the patients 8 out of 30 representing (26.6%) had RV systolic dysfunction.…”

“…As regards pulmonary stenosis, the study of Attalla et al (11) showed more than half of the patients 36 out of 56 had pulmonary stenosis (representing 64.3%). Similar to present study results that showed 18 out of 30 (60%) had MPA stenosis, with mean pressure gradient 33.06 (SD 8.12) mm/Hg.…”

“…The study of Attalla et al (11) was conducted on fifty-six patients, in which all of them underwent surgical repair for TOF. In such study, the majority of the patients 54 had RV dilatation (representing 96.4%), with p value ≤0.05.…”