Right Ventricular Remodeling Due to Pulmonary Regurgitation Is Associated With Reduced Left Ventricular Free Wall Strain in Surgically Repaired Tetralogy of Fallot

Additional mechanism for left ventricular dysfunction: chronic pulmonary regurgitation decreases left ventricular preload in patients with tetralogy of Fallot

“…19 Marked pulmonary regurgitation and right ventricular dilation have recently been described to affect the left ventricle early-diastolic radial and circumferential strain rates, 17 and myocardial deformation imaging has demonstrated reduction in left ventricular systolic indices even in patients with preserved left ventricular ejection fraction. 20,21 Accordingly, as many as 20% of late survivors of tetralogy of Fallot develop a concurrent left ventricular dysfunction, making it an important factor in the patient's late outcome. 8 An important finding of the present study is that, despite successful surgical repair carried out in our patients with tetralogy of Fallot, left atrial function was impaired.…”

“…, 18 In these patients, despite normal right ventricular and left ventricular ejection fractions measured with ultrasound, disturbed postoperative pathophysiology can be teased out by exercise to demonstrate the defective contractile reserve of the left ventricle 19 . Marked pulmonary regurgitation and right ventricular dilation have recently been described to affect the left ventricle early-diastolic radial and circumferential strain rates, 17 and myocardial deformation imaging has demonstrated reduction in left ventricular systolic indices even in patients with preserved left ventricular ejection fraction 20 21 Accordingly, as many as 20% of late survivors of tetralogy of Fallot develop a concurrent left ventricular dysfunction, making it an important factor in the patient’s late outcome 8 .…”

2020 ESC Guidelines for the management of adult congenital heart disease

“…A reduced LV free wall longitudinal strain has been reported despite preserved LVEF. 237 The incidence of clinical heart failure, with its typical signs and symptoms, increases significantly with age. 238 Underlying mechanisms may also be: damage to myocardium, sequelae from surgical repair strategies, or electrical conduction abnormalities.…”