Postsystolic Shortening Is Associated with Altered Right Ventricular Function in Children after Tetralogy of Fallot Surgical Repair

Abstract

The aim of the study was to determine whether segmental interactions, as expressed by postsystolic shortening (PSS), affects RV mechanics and are connected with impaired systolic and diastolic function in rTOF children. Patients and Methods: 55 rTOF adolescent (study group), and 34 healthy volunteers (control group) were examined using classical Doppler flow (Doppler), Tissue Doppler Imaging (TDI) and Speckle Tracking Echocardiography (STE). PSS was found to occur when time to peak (TTP) was longer than pulmonary valve closure time (PVCT). TTP and strain were derived from RV lateral segments—basal (BL), medial (ML) and apical (AL) in STE. PVCT was measured from the beginning of QRS complex in the ECG to the termination of Doppler flow at the pulmonary valve. TDI was obtained at the lateral tricuspid annulus site and the systolic (S′), early (E′) and late diastolic (A’) peak velocities were measured along with isovolumic contraction (IVCT), and relaxation (IVRT) time. PW was used to measure early tricuspid inflow velocity (E) for calculating the E/E’ ratio. The TDI data in patients with PSS presence (TTP>PVCT) and those in whom it did not occur (TTP≤PVCT) were compared. Results: PSS in BL, ML and AL were observed respectively in: 27(51,9%), 9 (18%), and 8 (16,7%) patients. Mean values of TTP in BL, ML, and AL were respectively: 420.6±55.5ms, 389.8±50.0ms and 366.7±59.0ms. PVCT mean value was 396.6±33.5ms. In the study group, the mean E’ in TTP>PVCT was significantly lower (4.8±1.8 cm/s) compared to mean E’ in TTP≤PVCT (8.4±2.6 cm/s), p<0.01. The average E/E’ was significantly higher in TTP>PCVT than in TTP≤PVCT, respectively 21.6±7.3 vs 12.2±5.1, p<0.05. IVRT was significantly prolonged in TTP>PVCT compared to IVRT in TTP≤PVCT, respectively 95.9±38.7 vs 77.0±35.1, p<0.05. Furthermore, in TTP>PVCT, significantly higher strain in BL (-28.8±8.7%) was observed when compared to that parameter in TTP≤PVCT (-35.3±13.1%), p <0.05. Conclusions: Tissue Doppler Echocardiography and Speckle Tracking Echocardiography are useful techniques for detecting regional systolic and diastolic dysfunction in children after Tetralogy of Fallot surgical repair. Postsystolic shortening in the basal lateral segment is commonly seen in children after the Tetralogy of Fallot surgical repair, and is associated with altered right ventricular systolic and diastolic function.

The right ventricular myocardial systolic-to-diastolic duration ratio in children after surgical repair of Tetralogy of Fallot

“…Because electromechanical dyssynchrony affects RV function in rTOF, the myocardial, but not the Doppler, index accounts for this important interval. The increased myocardial S/D duration ratio in rTOF is also impacted by increased RV basal and mid free wall PSS that stems from right bundle branch block electromechanical dyssynchrony in this population (15,20,27). PSS reflects inefficient myocardial contraction, since it does not contribute to ejection.…”

Usefulness of three-dimensional echocardiography for the assessment of ventricular function in children: Comparison with cardiac magnetic resonance, with a focus on patients with arrhythmia

“…For that reason, the accurate and regular assessment of ventricular function is crucial in patients with ventricular arrhythmia. Unfortunately, widely accessible and inexpensive two-dimensional echocardiography (2D-ECHO) offers very biased data because a singleplane view cannot illustrate the complex morphology of the right ventricle [14][15][16][17]. CMR is much more accurate in this assessment and is considered the gold standard in calculating ventricular volume and function.…”

Early signs of right ventricular systolic and diastolic dysfunction in acute severe respiratory failure: the importance of diastolic restrictive pattern

“…20 Moreover, TAPSE length with respect to the ECG, was also assessed and regarded as post-ejectional shortening when annular displacement peaked after the T wave on the ECG, meaning a pathological systolic contraction elongating during the proto-diastolic period. 20,21 The pulmonary artery systolic diameter was measured in modified parasternal long axis and parasternal short axis views. Pulmonary artery flow was measured by placing the pulsed-wave Doppler sample volume at the centre of the transpulmonary valve flow.…”