Right ventricular restrictive physiology in repaired tetralogy of Fallot is associated with smaller respiratory variability

Choi, Jae Young; Kwon, Hae Sik; Yoo, Byung Won; Smıth, Lee; Sul, Jun Hee; Park, Han Ki; Park, Young Hwan

doi:10.1016/j.ijcard.2007.02.020

Cited by 9 publications

(4 citation statements)

References 28 publications

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“…Accurate assessment of pulmonary regurgitation is important, because this is a key determinant of the outcome of patients with a corrected TOF ( 1,2 ). In addition, right ventricular diastolic dysfunction is frequently observed (3)(4)(5), with the estimated percentage of patients with a right ventricular restrictive fi lling pattern ranging from 35% to 66% ( 3,(5)(6)(7)(8)(9). Confl icting results re garding the implications of diastolic dysfunction-the role of right ventricular restriction in particular-in terms of the long-term prognosis for patients with a corrected TOF have been published ( 3,(5)(6)(7)(8)(9).…”

Section: Discussionmentioning

confidence: 99%

Tetralogy of Fallot: 3D Velocity-encoded MR Imaging for Evaluation of Right Ventricular Valve Flow and Diastolic Function in Patients after Correction

Hulst¹,

Westenberg²,

Kroft³

et al. 2010

Radiology

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Section: Discussionmentioning

confidence: 99%

Tetralogy of Fallot: 3D Velocity-encoded MR Imaging for Evaluation of Right Ventricular Valve Flow and Diastolic Function in Patients after Correction

Hulst¹,

Westenberg²,

Kroft³

et al. 2010

Radiology

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“…Total correction at an early age is the main surgical management in TOF patients. After total repair of TOF, many patients suffer a slow postoperative recovery, with an evidence of a raised central venous pressure, fluid retention, pleural effusion, a low cardiac output, ascites, right ventricular myocardial delayed enhancement and diastolic dysfunction [1, 2]. In the absence of significant residual ventricular septal defect (VSD) and obstructive lesions etc., it is very common that such patients have RVRP.…”

Section: Introductionmentioning

confidence: 99%

Etiology of right ventricular restrictive physiology early after repair of tetralogy of Fallot in pediatric patients

Bhushan

Huang

et al. 2019

J Cardiothorac Surg

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Background Right ventricular restrictive physiology (RVRP) is a common finding after repair of Tetralogy of Fallot (TOF). The characteristic feature of RVRP is the presence of a direct end-diastolic flow (EDFF) during atrial contraction in the main pulmonary artery. This end-diastolic forward flow is caused by increased right ventricular end-diastolic pressure due to right ventricular myocardial stiffness and decreased right ventricular compliance. Objective Our main objective is to found out the etiology of RVRP in pediatrics patients who underwent for complete repair of Tetralogy of Fallot (TOF). Methods A total of 50 TOF patients have registered for this study in our hospital from January 2017 to September 2018. The patients were divided in two groups, group A with restrictive physiology and group B without restrictive physiology. The patients selected for this study includes TOF patients, TOF patients with atrial septal defect (ASD), and TOF patients with patent ductus arteriosus (PDA). Ventricular hypertrophy and right heart enlargement were evaluated by electrocardiogram and echocardiography. The other parameters we used to compare between these two groups were sex, age, weight, cardio pulmonary bypass (CPB) time, aortic cross clamping time, transannular patch, SP0 2 , RV/LV pressure, ventricular hypertrophy, right heart (RH) enlargement, tricuspid annular plane systolic excursion (TAPSE), pulmonary artery systolic pressure (PASP), TAPSE/PASP ratio, pulmonary annular diameter, intubation time, PICU stay and hematocrit (HCT). Results RVRP was identified in 28 patients (58%). Lower SP0 2 (mean: 84.3 ± 7.9%) with p -value 0.015, transannular patch repair ( n = 22, 78.5%) with p-value< 0.001, longer cardiopulmonary bypass (CPB) time (mean: 117.6 ± 23 min) with p-value< 0.001, longer aortic cross clamping time (mean: 91.4 ± 20.26 min) with p-value< 0.001, lower TAPSE, lower PASP,lower TAPSE/PASP ratio and presence of hypertrophy (p-value < 0.001) were identified as etiology for restrictive physiology. It was also found that 77% TOF patients with ASD have a higher risk of RVRP in our study. Conclusions In TOF patient’s etiology for right ventricular restrictive physiology are associated with lower SP0 2, transannular patch repair, longer CPB and longer aortic cross clamping time, hypertrophy, lower TAPSE, lower PASP and lower TAPSE/PASP ratio.

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“…A total of 552 citations were identified, of which 83 publications were potentially relevant and retrieved as full text. Forty‐five reports 5 , 6 , 7 , 8 , 11 , 12 , 13 , 14 , 15 , 16 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 of 42 individual studies fulfilled our eligibility criteria (Figure 1 ). Characteristics of each study and its participants are shown in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

End‐Diastolic Forward Flow and Restrictive Physiology in Repaired Tetralogy of Fallot: A Systematic Review and Meta‐Analysis

Eynde

Derdeyn

Schuermans

et al. 2022

JAHA

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Background Pulmonary arterial end‐diastolic forward flow (EDFF) following repaired tetralogy of Fallot has been thought to represent right ventricular (RV) restrictive physiology, but is not fully understood. This systematic review and meta‐analysis sought to clarify its physiological and clinical correlates, and to define a framework for understanding EDFF and RV restrictive physiology. Methods and Results PubMed/MEDLINE, Embase, Scopus, and reference lists of relevant articles were searched for observational studies published before March 2021. Random‐effects meta‐analysis was performed to identify factors associated with EDFF. Forty‐two individual studies published between 1995 and 2021, including a total of 2651 participants (1132 with EDFF; 1519 with no EDFF), met eligibility criteria. The pooled estimated prevalence of EDFF among patients with repaired tetralogy of Fallot was 46.5% (95% CI, 41.6%–51.3%). Among patients with EDFF, the use of a transannular patch was significantly more common, and their stay in the intensive care unit was longer. EDFF was associated with greater RV indexed volumes and mass, as well as smaller E‐wave velocity at the tricuspid valve. Finally, pulmonary regurgitation fraction was greater in patients with EDFF, and moderate to severe pulmonary regurgitation was more common in this population. Conclusions EDFF is associated with dilated, hypertrophied RVs and longstanding pulmonary regurgitation. Although several studies have defined RV restrictive physiology as the presence of EDFF, our study found no clear indicators of poor RV compliance in patients with EDFF, suggesting that EDFF may have multiple causes and might not be the precise equivalent of RV restrictive physiology.

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Right ventricular restrictive physiology in repaired tetralogy of Fallot is associated with smaller respiratory variability

Cited by 9 publications

References 28 publications

Tetralogy of Fallot: 3D Velocity-encoded MR Imaging for Evaluation of Right Ventricular Valve Flow and Diastolic Function in Patients after Correction

Tetralogy of Fallot: 3D Velocity-encoded MR Imaging for Evaluation of Right Ventricular Valve Flow and Diastolic Function in Patients after Correction

Etiology of right ventricular restrictive physiology early after repair of tetralogy of Fallot in pediatric patients

End‐Diastolic Forward Flow and Restrictive Physiology in Repaired Tetralogy of Fallot: A Systematic Review and Meta‐Analysis

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