Right ventricular volume characteristics before and after palliative and reparative operation in tetralogy of Fallot.

Abstract

SUMMARY Right heart volume data were obtained in 63 patients with tetralogy of Fallot. The patients were divided into three groups: 1) preoperative tetralogy (N=34); 2) post shunt procedure (N= 14); 3A) post repair without outflow patch (N= 10); 3B) post repair with an outflow patch (N=8). In Group 1 right ventricular end-diastolic volume (RVEDV), RV ejection fraction (EF), and RV systolic output (SO) were all mildly depressed. In post shunt patients, RVEDV was normal but RVEF remained depressed. RVEDV and RVSO increased following a shunt procedure, and these variables were larger in patients with a large versus a small shunt. In Group 3A RVEDV, ALTHOUGH TREATMENT for suspected right ventricular (RV) failure is common after tetralogy of Fallot repair, very little information is available on the direct measurement of RV performance in these patients. Such measurements may become increasingly important in the evaluation of current methods of treatment for both the infant and the older child with tetralogy of Fallot. The purpose of this investigation, therefore, was to analyze biplane cineangiocardiograms in patients before and after surgery for tetralogy of Fallot to determine right ventricular end-diastolic and end-systolic volumes, ejection fraction, systolic output, and maximum right atrial volume and to attempt to correlate these findings with clinical course and other pertinent hemodynamic data. MethodsAll patients studied at Vanderbilt Hospital from July 1971 to October 1975 with the diagnosis of tetralogy of Fallot and adequate biplane cineangiocardiograms for analysis were included. Tetralogy of Fallot was defined as the condition in which there is a large ventricular septal defect with equal right and left ventricular peak systolic pressures associated with right ventricular outflow tract obstruction, and bidirectional shunting. There were three basic patient groups.Group 1 consisted of patients prior to any surgical procedure. There were 34 studies performed on 32 patients in this group whose ages ranged from 3 days to 12 years with an average age of 2.1 ± 0.4 yr (mean ± SEM). Sixteen patients were less than one year of age and 24 were less than two years. Arterial oxygen saturation (02 SAT) ranged from 67-98% at rest and averaged 80 ± 2%. Only four patients had arterial 02 SATs at rest . 90%, and all four had a de- 417RVEF, and RVSO were normal. In contrast in patients in Group 3B, RVEDV was increased averaging 177 ± 15% of normal, RVEF was depressed averaging 0.45 ± 0.04, and RVSO was normal. RV size and pump function are abnormal in patients whose operation requires an outflow tract patch and the factors which may contribute to these abnormalities include a higher RV peak pressure, pulmonary incompetence, and a larger noncontractile outflow tract. Longitudinal studies relating these variables to clinical performance and exercise testing will be important in assessment of the importance of these abnormalities.crease in 02 SAT with crying. Hematocrits ranged from 36-73% with an average of 47 ± 2%, tabl...

Echocardiographic study of right and left ventricular dimension and left ventricular function in patients with tetralogy of Fallot before and after surgery.

“…Though none of them died, 3 of them had stormy postoperative courses with prolonged left ventricular failure. We are, therefore, not convinced that small left ventricular volumes are an indication for palliation rather than corrective surgery (Graham et al, 1976). The causes of the left ventricular underdevelopment in tetralogy of Fallot patients are not well known.…”

“…This ventricular function even remained depressed when palliative shunt procedures preceded corrective surgery, though left ventricular and left atrial volumes and mass increased significantly after palliation (Jarmakani et al, 1972;Graham et al, 1976).…”

“…'Preliminary results of this work were presented at the 15th Annual General Meeting of the Association of European Pediatric Cardiologists in Ghent, Belgium, 4-6 May 1977. Received for publication 4 January 1978 surgery showed impaired function of varying degree (Levin et al, 1966;Jarmakani et al, 1972;Graham et al, 1971Graham et al, , 1976. This ventricular function even remained depressed when palliative shunt procedures preceded corrective surgery, though left ventricular and left atrial volumes and mass increased significantly after palliation (Jarmakani et al, 1972;Graham et al, 1976).…”

Congenital Heart Defects in Adults : A Field Guide for Cardiologists

“…TR can be progressive and compounds the RV dilation. Late RV dilation and dysfunction are common [115]. Progressive aortic regurgitation, usually associated with aortic root dilation, has been reported to occur in 15–18% of patients [116,117].…”

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

“…On the other hand, reports concerning the late mortality and functional deterioration on long-term follow-up are emerging [1][2][3][4][5][6][7][8][9][10] and it has been well documented that the long-term outcome of patients with repaired TOF is related to right ventricular (RV) volume overload, severity of pulmonary insufficiency (PI) and the type of outflow repair [1][2][3][4][5][6][7][8][10][11][12]. Recently, a new concept of restrictive right ventricular physiology (RVRP) in repaired TOF patients had been introduced and known to be related to less RV dilatation, less prolongation of QRS duration, less symptomatic ventricular arrhythmia, and more favorable late outcome [9,13,14], but some conflicting results [15][16][17] have also been reported, and the relationships among the influencing factors are not clearly understood.…”