Risk Factors for Late Right Ventricular Systolic Dysfunction in Pediatric Patients With Repaired Tetralogy of Fallot

Abstract

SummaryTo evaluate independent risk factors for late right ventricular systolic dysfunction after correction of Tetralogy of Fallot (TOF) in a single-centre, retrospective and observational clinical trial.Patients less than 3 years of age who underwent correction of TOF and subsequently routine clinical follow-up of more than 36 months were included in this study and were divided either into an experimental group (right ventricular systolic dysfunction) or a control group (normal right ventricular systolic function) according to the tricuspid annular peak systolic velocity (TAPSV) value measured by pulsed wave-tissue Doppler imaging (pulsed wave-TDI). The relevant data of all selected patients were investigated and analyzed.From January 2012 to December 2012, a total of 113 consecutive eligible patients were enrolled in this study and were divided either into an experimental group (n = 41) or control group (n = 72). Through univariate analysis and subsequent logistic regression, low preoperative arterial oxygen saturation (OR = 1.66, 95%CI 1.22-4.58, P = 0.0163), age less than 6 months at the time of surgery (OR = 3.45, 95%CI 1.87-9.17, P = 0.0021), and transannular patch (OR = 2.15, 95%CI 1.31-5.38, P = 0.0015) were 3 independent risk factors for late right ventricular systolic dysfunction after correction of TOF.This clinical trial suggested low preoperative arterial oxygen saturation was associated with late right ventricular systolic dysfunction after correction of TOF, and appropriate age at the time of surgery and selection of a proper surgical method to reconstruct the right ventricular outflow tract contributed to improving late right ventricular systolic function in pediatric patients with repaired TOF. (Int Heart J 2015; 56: 80-85)

Regression equations for calculation ofzscores for echocardiographic measurements of right heart structures in healthy Han Chinese children

“…Accurate measurement of right heart structures is important in the management of congenital and acquired heart disease in children, especially those with right heart anomalies such as hypoplastic right heart syndrome, corrected transposition of the great arteries, pulmonary atresia, tricuspid atresia, and Ebstein malformation. Cardiologists and surgeons must determine whether the right heart structures are hypoplastic, whether there is right heart dysfunction, and whether the right ventricle can support systemic circulation . Because the heart grows throughout childhood, interpretation of measurements of cardiac structures must take into account the patient's body size, which is commonly performed by calculating z scores for the values adjusted for BSA.…”

“…Fractional area change is a two‐dimensional surrogate for change in RV volume and may approximate overall function in a more time‐efficient manner than ejection fraction. It has the advantage of encompassing both the longitudinal and the radial components of RV contraction, but it neglects the role of the RVOT and contractility and, as such, is only partially representative of the entire right ventricle . Novel measurements by Lindqvist et al, such as estimating RVOTFS, may prove to be the complement to fractional area change .…”

“…Until recently, normative data of the two‐dimensional echocardiographic measurements for commonly measured right cardiac structures have not been extensively investigated in a large cohort of healthy children, in part because cardiology research concentrated on evaluation of the left heart . However, breakthroughs in cardiovascular diagnostics and cardiothoracic surgery have recently been achieved, and with the widespread adoption of the arterial switch procedure and Fontan procedure for transposition of the great arteries, pulmonary atresia, tricuspid atresia, and Ebstein malformations, determination of right ventricular function in children with congenital right heart disease has gained attention …”

Sustained Improvement in Right Ventricular Chamber Dimensions 10 Years Following Xenograft Pulmonary Valve Replacement

“…The indications for operation and subsequent reintervention were (1) peak Doppler-derived right ventricular outflow tract gradient of greater than 3/4 of the systemic arterial pressure, (2) severe PI by echocardiogram resulting in right ventricular dilation (2001)(2002)(2003)(2004)(2005), and/or (3) PI by cardiac magnetic resonance (CMR) studies indicating a right ventricular end-systolic index of >150. Briefly, prior to the administration of heparin, autologous blood is used to preclot the graft, and the distal portion of the Dacron graft is excised, leaving only a 1-to 2-mm rim adjacent to the distal end of the stented prosthesis.…”

“…The deleterious effects of chronic pulmonary insufficiency (PI) and stenosis resulting in biventricular failure, arrhythmias, and sudden death have been well documented. 1,2 Fortunately, for the majority of patients, improvements in right ventricular function are observed following pulmonary valve replacement (PVR). 3 Right ventricular dimensions, volume, and heart failure symptoms decrease following PVR and are the result of reducing the right ventricular volume and pressure.…”