Pulmonary regurgitation: not a benign lesion

Bouzas, Beatriz; Kilner, Philip J.; Gatzoulis, Michael Α.

doi:10.1093/eurheartj/ehi091

Cited by 301 publications

(226 citation statements)

References 40 publications

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“…3 and 4). Similar findings were obtained in Boston [18], by applying a cutoff value of 160 mL/m 2 , and in Toronto, by applying a cutoff of 170 mL/m 2 [14]. Interestingly, remodelling in RV size did not correspond to an improvement in global right ventricular function, expressed as ejection fraction, in either report.…”

Section: Volume Overloadsupporting

confidence: 76%

“…On the basis of these observations reported in the last decade, the previous common opinion that pulmonary regurgitation may be well tolerated by the RV has recently been revised [14]. The observation reported by Therrien et al, that RV with an enddiastolic volume larger than 170 mL/m 2 may not regress to normal size after pulmonary valve replacement, provided more evidence in favour of a different approach to this problem [15].…”

Section: Volume Overloadmentioning

confidence: 99%

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The right ventricle in tetralogy of Fallot

Stambach¹,

Valsangiacomo²

2009

Schweiz Ärzteztg

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Surgical repair of tetralogy of Fallot (TOF) may be followed by various conditions and residual findings, early postoperatively or late during follow-up. Most of these conditions affect the right ventricular outflow tract and the pulmonary arteries and thus, indirectly, the right ventricle.This paper discusses the role of the right ventricle during the natural history of repaired TOF. The different imaging methods used to assess the function of the right ventricle in relation to this congenital heart disease are highlighted. Particular attention is focused on the volume overloaded right ventricle, as this condition is nowadays a subject of intense discussion, particularly regarding the appropriate timing for pulmonary valve replacement. The most recent literature on this topic is briefly reviewed. In summary, preservation of right ventricular function and prevention of right ventricular arrhythmias are crucial for these patients' survival and outcome. Key words: right ventricle; tetralogy of Fallot; pulmonary regurgitation IntroductionTetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease, occurring in 0.04-0.08% of all liveborns [1, 2]. The main feature of TOF is a ventricular septum defect with anterior deviation of the outlet septum, leading to infundibular subpulmonary stenosis and placing the aorta in an overriding position; in addition, valvular pulmonary stenosis with possible hypoplasia of the main pulmonary artery and its side branches occurs, together with hypertrophy of the right ventricle (RV) ( fig. 1).Besides closing the ventricular septal defect, surgical repair consists of reconstruction of the right ventricular outflow tract (RVOT). RVOT reconstruction can be performed by various surgical techniques, some resulting in residual RVOT obstruction (commissurotomy) and others completely relieving the obstruction at the price of causing pulmonary regurgitation (transannular patch). Thus the surgical technique used usually determines the postoperative findings and eventually the patients' long-term outcome. However, the surgical technique providing the best outcome for the patients has not yet been defined, and the type of repair is chiefly determined by the personal strategy of the operating surgeon in each individual centre. Surgical repair can be performed during the first months of life, ideally at the age of 3 to 4 months, with low perioperative mortality. Long-term mortality was studied by Nollert et al., who reported a 20-year survival rate of 94% [3]. Nevertheless, the survival curve seems to deteriorate after 25 years post TOF repair [3], and significant residual findings may occur resulting in significant morbidity during follow-up. Similarly, Oechslin et al. reported a cumulative percentage of reinterventions required in TOF patients [4]. The most common indications for reintervention consisted of lesions affecting the (RVOT 75%), including severe pulmonary regurgitation, conduit failure and RVOT obstruction. Due to their anatomical location, all these findings may ev...

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Section: Volume Overloadsupporting

confidence: 76%

Section: Volume Overloadmentioning

confidence: 99%

The right ventricle in tetralogy of Fallot

Stambach¹,

Valsangiacomo²

2009

Schweiz Ärzteztg

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“…Following surgical correction, many patients have moderate to severe pulmonary insufficiency (PI) with minimal or no residual pulmonary stenosis (PS). Chronic PI plays a pivotal role in right ventricular (RV) dilatation and dysfunction, following surgical repair of RV outflow tract (RVOT) obstruction (2)(3)(4)(5)(6)(7)(8). Most patients following surgical correction of TOF experience a prolonged asymptomatic phase.…”

Section: Introductionmentioning

confidence: 99%

CMR assessment of right ventricular function in patients with combined pulmonary stenosis and insufficiency after correction of tetralogy of Fallot

et al. 2013

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Background: Tetralogy of Fallot (TOF) is one of the most common types of congenital heart disease and requires prompt surgical correction. Post-correction pulmonary insufficiency (PI) often ensues in adulthood. At times, the PI is accompanied by residual pulmonary stenosis (PS). Little is known regarding right ventricular (RV) function in the setting of combined PS and PI. Purpose: To compare cardiac magnetic resonance (CMR) parameters for the assessment of RV function between patients with combined pulmonary stenosis and pulmonary insufficiency (PSPI) and isolated PI following surgical repair of TOF. Material and Methods: Retrospective review of patients with comparable corrected TOF and similar PI was performed. Seventeen patients (median age, 24 years; range, 10-52 years) had combined PSPI and 30 patients (median age, 30 years; range, 6-70 years) had isolated PI. Cine magnetic resonance (MR) images (Philips Medical Systems, Best, The Netherlands) in the short-axis plane were used to calculate end-systolic, end-diastolic, and stroke volumes (RVESV, RVEDV, RVSV) and to measure RV wall thickness. Velocity-encoded cine MR images were used to measure pulmonary regurgitation fraction (PRF) by calculating the ratio of backward flow and total forward flow, obtained from the main pulmonary flow analysis. Peak pressure gradient across the pulmonary valve was obtained from spectral Doppler echocardiography. Results: RVEF was 51 AE 8% in the PSPI patients and 39 AE 11%, in the patients with isolated PI (P ¼ 0.001). Additionally, RV wall thickness was 5.2 AE 0.8 mm in the PSPI patients compared to 2.6 AE 0.9 mm in the isolated PI patients (P ¼ 0.001). RVESVi and RVEDVi were significantly lower (P < 0.05) in patients with combined PSPI (60 AE 21 mL/m 2 , 121 AE 35 mL/m 2 , respectively) compared to the patients with isolated PI (95 AE 48 mL/m 2 , 152 AE 61 mL/m 2 , respectively). Conclusion: RV function is preserved in patients with PSPI when compared to patients with PI following surgical repair of TOF.

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“…Intracardiac repair of tetralogy of Fallot has been performed for over 40 years with excellent short and long-term results (1,2); however, morbidity and mortality remain a major concern after surgical therapy (3). Pulmonary regurgitation is the most common sequels of surgery (3).…”

Section: Introductionmentioning

confidence: 99%

“…Pulmonary regurgitation is the most common sequels of surgery (3). Pulmonary regurgitation seems to be well tolerated by children in the early period (4); however, pulmonary regurgitation leads to progressive right ventricular dilatation, dysfunction, exercise intolerance, ventricular tachycardia, and finally, sudden cardiac death (5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Angiocardiography and magnetic resonance imaging to assess pulmonary regurgitation in repaired tetralogy of Fallot

Erdoğan¹,

Çeliker²,

Hazırolan³

et al. 2010

Anadolu Kardiyol Derg

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Objective: This study aimed to compare the results of angiocardiography and cardiovascular magnetic resonance imaging in the assessment of pulmonary regurgitation following repair of tetralogy of Fallot. Methods: We prospectively studied 37 patients with repaired tetralogy of Fallot. After routine examination cardiovascular magnetic resonance imaging (CMR) and cardiac catheterization and angiography were performed. Pulmonary regurgitation (PR) was classified according to the following criteria, using a left lateral angiogram of the main pulmonary artery; insufficiency jet is limited to right ventricular outflow tract (mild); jet reaches the body of right ventricle (moderate); jet fills the apex of the right ventricle (severe). Results: Pulmonary regurgitation determined by angiocardiography and CMR was severe in 51.4% and 32.4%, moderate in 27% and 40.5%, and none or mild in 21.6% and 27% of patients respectively. The ability of semi-quantitative estimation of PR determined by cardiac catheterization to distinguish between mild, moderate and severe pulmonary regurgitation was shown to have significant correlation with pulmonary regurgitant fraction obtained by CMR. Conclusions: Angiography obtained during invasive study can be used for the diagnosis and follow-up of pulmonary regurgitation confidently in patients with repaired tetralogy of Fallot and residual pulmonary regurgitation. (Anadolu Kardiyol Derg 2010; 10: 353-7) Key words: Pulmonary valve insufficiency, angiography, cardiac magnetic resonance imaging, tetralogy of Fallot follow-up ÖZET Amaç: Bu çalışma pulmoner yetmezliğin miktarının belirlenmesinde anjiyokardiyografi ve kardiyovasküler manyetik rezonans görüntüleme sonuç-larının karşılaştırılması amaçlanarak prospektif olarak planlanmıştır. Yöntemler: Fallot tetralojisi nedeniyle tüm düzeltme ameliyatı yapılmış 37 hasta çalışmaya dahil edilmiştir. Hastalara rutin muayene sonrası kardiyovasküler manyetik rezonans görüntüleme (CMR) ile kalp kateterizasyonu ve anjiyografi uygulanmıştır. Pulmoner yetmezlik ana pulmoner artere sol yan pozisyonda yapılan anjiyogramla aşağıdaki kriterler doğrultusunda belirlendi: Yetmezlik jeti sağ ventrikül çıkış yolu ile sınırlı ise hafif; sağ ventrikül gövdesine kadar uzanıyorsa orta; sağ ventrikül apeksini dolduruyor ise ağır pulmoner yetmezlik olarak değerlendirilmiştir. Bulgular: Anjiyokardiyografi ile pulmoner yetmezlik miktarı hastaların %51.4'ünde ağır, %27'sinde orta, %21.6'sında hafif bulunmuştur. Pulmoner yetmezlik miktarı CMR ile ise hastaların %32.4'ünde ağır, %40.5'inde orta ve %27'sinde hafif olarak saptanmıştır. Çalışma sonucunda kalp kateterizasyonu ile saptanan hafif, orta ve ağır pulmoner yetmezliğin miktarlarının manyetik rezonans görüntüleme yöntemi ile elde edilen sonuçlarla yüksek oranda uyumluluk gösterdiği görüldü. Sonuç: Bu çalışma sonucunda Fallot tetralojisi nedeniyle tüm düzeltme ameliyatı yapılmış hastaların uzun dönem izlemlerinde pulmoner yetmezliğin miktarını belirlemek için girişimsel çalışmalar sırasında uygulanan anjiyografi görüntülerin...

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Pulmonary regurgitation: not a benign lesion

Cited by 301 publications

References 40 publications

The right ventricle in tetralogy of Fallot

The right ventricle in tetralogy of Fallot

CMR assessment of right ventricular function in patients with combined pulmonary stenosis and insufficiency after correction of tetralogy of Fallot

Angiocardiography and magnetic resonance imaging to assess pulmonary regurgitation in repaired tetralogy of Fallot

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