Quantitative analysis of right atrial performance after surgical repair of tetralogy of Fallot

Abstract

We aimed to assess the right atrial performance in patients after surgical correction of tetralogy of Fallot, and to clarify the relationship between the pump function of the right atrium and right ventricular systolic function. We included in the study 50 asymptomatic patients following corrective surgery of tetralogy of Fallot, comparing them to 30 normal subjects. Right atrial areas were measured by echocardiography, and the active fractional area of emptying was expressed, in percentages, as the area measured at the onset of atrial contraction, minus the minimal area, divided by the area at the onset of atrial contraction. We used this value to assess the atrial pump function. Right atrial peak strain rates were measured by tissue Doppler imaging. Compared to controls, patients with tetralogy of Fallot had a significantly reduced right atrial active fractional area of emptying (p = 0.005), along with a reduced peak late diastolic strain rate (p = 0.002). Among 20 patients who underwent magnetic resonance tomographic examination, a relatively higher right atrial peak late diastolic strain rate was shown in patients with a right ventricular ejection fraction of less than 50% (p = 0.021). Right atrial performance is reduced in patients after surgical correction of tetralogy of Fallot. When facing right ventricular systolic dysfunction, nonetheless, the right atrial pump function may be relatively enhanced. Tissue Doppler derived strain rate can provide quantitative analysis of regional right atrial performance.

Integrated analysis of atrioventricular interactions in tetralogy of Fallot

“…These findings were associated with simultaneously diminished RA pump function (atrial kick), as evidenced by decreased late diastolic RA emptying fraction and strain rate. This observation is in line with several studies (7,15) that reported a reduced active atrial pump function in volume-loaded ventricles. Other authors (7, 10, 28) have reported increased active atrial performance in the presence of severe, isolated pressure loaded LVs or RVs, for example, in the setting of pulmonary hypertension.…”

“…Strain and strain rate were obtained in early diastole, late diastole, and systole on the basis of three cardiac cycles in the apical four chamber view (15,17,18). Peak strain was measured independently of aortic and pulmonary valve closure, and a mean value was calculated from the three measuring points.…”

“…Recent studies (5,22,27) that have investigated the complex adaptive response of the RV to chronic overload in TOF have provided evidence that the RV cannot be seen as one entity. In addition, the impact of RV dysfunction on left ventricular (LV) and atrial function must be considered (1,12,15,26). In 1974, Suga (25) highlighted the role of the atria in cardiac performance by transforming the continuous venous return into the intermittent ventricular filling flow.…”

“…Studies (10,21,28) have been conducted that assessed components of RA function in animals and humans with pulmonary arterial banding or pulmonary hypertension. A study by Hui and coworkers (15) investigated TOF patients with a focus on late atrial active emptying, the so-called atrial kick. However, a more systematic assessment of RA function that accounts for both filling and emptying parameters has not yet been studied in TOF patients with RV dysfunction.…”

Right Atrial Deformation in Predicting Outcomes in Pediatric Pulmonary Hypertension

“…This type of RA-RV coupled relationship, with increased RV afterload and diastolic dysfunction, has also been observed in patients with repaired Tetralogy of Fallot and adult PH 16, 21 . Although RA function correlated with RV LS, RV LS was not a predictor of adverse clinical events in this cohort, but the study may be underpowered to detect this.…”