Tetralogy of Fallot : Transannular and Right Ventricular Patching Equally Affect Late Functional Status

d’Udekem, Yves; Ovaert, Caroline; Grandjean, F.; Gerin, V.; Cailteux, Madeleine; Shango-Lody, P.; Vliers, André; Sluysmans, Thierry; Robert, Annie; Rubay, Jean

doi:10.1161/01.cir.102.suppl_3.iii-116

Cited by 68 publications

(55 citation statements)

References 11 publications

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“…1a) consists of alterations in diastolic right ventricular (RV) loading conditions, triggering RV hypertrophy, and dilatation. 2,9,18,27 In turn, RV dilatation can evolve into irreversible RV myocardial contractile dysfunction, and has been implicated in the development of fatal RV arrhythmias. 18,37 To avoid this outcome, therapies are directed at the normalization of RV loading conditions via PV replacement (PVR), preferably performed prior to the onset of irreversible RV myocardial damage.…”

Section: Introductionmentioning

confidence: 99%

“…However, if deferred too long, RV myocardial contractile dysfunction may become irreversible, despite the valve replacement. 9,19,26,27,37 Unfortunately, the progression in RV dilatation to subsequent RV dysfunction in repaired rTOF patients with PI is difficult to determine clinically or with currently available clinical tests, such as echocardiography or standard cardiac MRI (CMR). For example, echocardiography, the mainstay of pediatric cardiac diagnoses and management for nearly three decades, is limited in its ability to characterize the RV.…”

Section: Introductionmentioning

confidence: 99%

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Right Ventricular Inefficiency in Repaired Tetralogy of Fallot: Proof of Concept for Energy Calculations From Cardiac MRI Data

2010

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Repaired tetralogy of Fallot (rTOF) patients develop right ventricular (RV) dilatation and dysfunction. To prevent their demise, pulmonary valve replacement is necessary, though appropriate timing for it is challenged by a paucity of reliable diagnostic parameters. In this pilot study, we hypothesized that stroke work (SW) and energy calculations would delineate the inefficiency of RV performance in rTOF. RV SW was calculated for both an rTOF and a normal subject by utilizing RV pressure and volume measurements obtained during cardiac catheterization and MRI studies. Energy transfer rate and ratio were computed at the main pulmonary artery (PA). Compared to the normal RV, the rTOF RV had higher operating pressure, lower computed SW (0.078 J vs. 0.115 J for normal), and higher negative energy transfer at the PA (0.044 J vs. 0.002 J for normal). Furthermore, the energy transfer ratio was nearly twice as high for the normal RV (1.06) as for the rTOF RV (0.56). RV SW and energy transfer ratio delineate important operational efficiency differences in blood flow from the RV to the PA between rTOF and normal subjects. Our pilot data suggest that the rTOF RV is significantly less efficient than normal.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Right Ventricular Inefficiency in Repaired Tetralogy of Fallot: Proof of Concept for Energy Calculations From Cardiac MRI Data

2010

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“…In fact, excess enlargement of the RVOT may cause a A B significant amount of the PR. However, some investigators demonstrated that TAP repair in itself does not result in a worse late functional outcome than other types of repair in which the RV incision is limited to the ventricle (17). Those investigators argue that both TAP repair and RV-tomy repair are responsible for a similar degree of long-term PR and the same degree of the RV dilatation.…”

Section: Discussionmentioning

confidence: 99%

Predictors of ventricular tachyarrhythmia occurring late after intracardiac repair of tetralogy of Fallot: combination of QRS duration change rate and tricuspid regurgitation pressure gradient

et al. 2017

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Background: To determine potential predictors of ventricular tachyarrhythmia and sudden cardiac death (SCD) occurring late after repair of tetralogy of Fallot (TOF). Methods: Since 1964, 415 patients had undergone total repair for TOF at Niigata University Hospital. Of these, 89 patients who were followed for more than 10 years at our institute were retrospectively reviewed. Results: The mean follow-up period was 24.3 years. During the study period, one patient died of cerebral bleeding, and two patients had SCD. The overall survival rates at 20, 30, and 40 years were 100%, 94.6%, and 94.6%, respectively. Eight (9.0%) patients required re-intervention during the late period associated with right ventricular outflow (n=4), tricuspid valve (n=3), aortic valve (n=2), and others (n=2). Ten (11.2%) patients had a history of ventricular tachycardia (VT) or ventricular fibrillation (VF), and six underwent implantation of an implantable cardiac defibrillator. Multivariate analysis selected the change rate of QRS duration [ms/year; odds ratio (OR), 2.44; 95% confidence interval (CI): 1.28-4.65; P=0.007] and the pressure gradient at tricuspid valve regurgitation on echocardiography (OR, 1.12; 95% CI: 1.02-1.22; P=0.017) as risk factors for VT/VF or SCD. Trans-annular patch (TAP) repair was not an independent risk factor for ventricular arrhythmia. Conclusions: The combination of rapid change rate of QRS duration and higher-pressure gradient at tricuspid regurgitation were risk factors for ventricular tachyarrhythmia late after TOF repair. Adequate surgical or catheter intervention for pressure and volume load in the right ventricle might decrease the prevalence of VT/VF and SCD.

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“…Thus, many patients are committed to a new modified history of chronic pulmonary regurgitation and RV volume overload. 5 As a consequence, pulmonary valve replacement (PVR) has become the most common operation undertaken for adults with congenital heart disease, 6 and the optimal management of patients who may have clinical or physiological indications for PVR has been widely researched and debated.…”

Section: Editorial See P 1855 Clinical Perspective On P 1868mentioning

confidence: 99%

Physiological and Phenotypic Characteristics of Late Survivors of Tetralogy of Fallot Repair Who Are Free From Pulmonary Valve Replacement

et al. 2013

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Background-Pulmonary valve replacement (PVR) after repair of tetralogy of Fallot is commonly required and is burdensome. Detailed anatomic and physiologic characteristics of survivors free from late PVR and with good exercise capacity are not well described in a literature focusing on the indications for PVR. Methods and Results-Survival and freedom from PVR were tracked in 1085 consecutive patients receiving standard tetralogy of Fallot repair in a single institution from 1964 to 2009. Of 152 total deaths, 100 occurred within the first postoperative year. Surviving patients between 10 and 50 years of age had an annual risk of death of 4 (confidence limit, 2.8-5.4) times that of normal contemporaries. To date, 189 patients have undergone secondary PVR at mean age of 20±13 years (36% of those alive at 40 years of age). A random sample of 50 survivors (age, 4-57 years) free from PVR underwent cardiovascular magnetic resonance, echocardiography, and exercise testing. These patients had mildly dilated right ventricles (right ventricular end-diastolic volume=101±26 mL/m 2 ) with good systolic function (right ventricular ejection fraction=59±7%). Most had exercise capacity within normal range (z peak V i o 2 =−0.91±1.3; z V i e/V i co 2 =0.20±1.5). In patients >35 years of age with normal exercise capacity, there was mild residual right ventricular outflow tract obstruction (mean gradient, 24±13 mm Hg), pulmonary annulus diameters <0.5z, and unobstructed branch pulmonary arteries. Conclusions-An important proportion of patients require PVR late after tetralogy of Fallot repair. Patients surviving to 35 years of age without PVR and with a normal exercise capacity may have had a definitive primary repair; their right ventricular outflow tracts are characterized by mild residual obstruction and pulmonary annulus diameter <0.5z.

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Tetralogy of Fallot : Transannular and Right Ventricular Patching Equally Affect Late Functional Status

Cited by 68 publications

References 11 publications

Right Ventricular Inefficiency in Repaired Tetralogy of Fallot: Proof of Concept for Energy Calculations From Cardiac MRI Data

Right Ventricular Inefficiency in Repaired Tetralogy of Fallot: Proof of Concept for Energy Calculations From Cardiac MRI Data

Predictors of ventricular tachyarrhythmia occurring late after intracardiac repair of tetralogy of Fallot: combination of QRS duration change rate and tricuspid regurgitation pressure gradient

Physiological and Phenotypic Characteristics of Late Survivors of Tetralogy of Fallot Repair Who Are Free From Pulmonary Valve Replacement

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