Ventricular size and function assessed by cardiac MRI predict major adverse clinical outcomes late after tetralogy of Fallot repair

Knauth, Alison; Gauvreau, K.; Powell, A.; Landzberg, Michael J.; Walsh, Edward P.; Lock, James E.; Nido, Pedro J. del; Geva, Tal

doi:10.1136/hrt.2006.104745

Cited by 451 publications

(256 citation statements)

References 29 publications

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“…12,14,23 In addition to volumes, CMR can also provide additional data on ejection fraction of both the RV and LV. In a cross-sectional study, Knauth et al 24 examined 88 patients with repaired TOF by CMR. Median time between TOF repair and enrollment in the study was 20.7 years, and median follow-up was 4.2 years.…”

Section: Cardiac Magnetic Resonance Measurements As An Indication Formentioning

confidence: 99%

“…28 Of course, LV function is an important predictor of outcome and, in the study by Knauth and colleagues mentioned above, diminished LV ejection fraction was as strong a predictor of adverse events as RV dysfunction. 24 Therefore, among patients with severe PR and diminished RV function, the addition of LV dysfunction would be an additional indication for PVR.…”

Section: Cardiac Magnetic Resonance Measurements As An Indication Formentioning

confidence: 99%

“…(Reprinted with permission. 24 ) rior periosteum intact and divide this layer with the electrocautery to avoid damage to underlying structures. If bleeding from the heart, most commonly the right atrium or right ventricle is encountered during resternotomy, the sternum should be reapproximated with towel clips and peripheral cannulation for cardiopulmonary bypass achieved before completing the sternotomy.…”

Section: Indications For Pvrmentioning

confidence: 99%

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Timing and Technique of Pulmonary Valve Replacement in the Patient With Tetralogy of Fallot

Tweddell

Simpson

et al. 2012

Seminars in Thoracic and Cardiovascular Surgery: Pediatric Card

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Residual right ventricular (RV) outflow tract pathology is universal among patients with repaired tetralogy of Fallot, and pulmonary regurgitation (PR) is also commonly present. Although tolerated in early life, by the second decade of life PR is associated with an increased risk of death because of ventricular arrhythmias. Pulmonary valve replacement (PVR) is a safe procedure that will eliminate PR, but timing and indications are evolving. Patients with arrhythmias or prolonged QRS duration are candidates for PVR. Patients with symptomatic exercise intolerance are likely to have improvement in symptoms and quality of life and should be offered PVR. Cardiac magnetic resonance has become an essential component of the management of the patient with tetralogy of Fallot with PR, and has identified the potential for and limitations of RV remodeling following PVR. Among patients with severe RV enlargement, particularly those with diminished RV or left ventricular function, there is an increased risk of adverse events and even asymptomatic patients with severe PR should be considered for PVR. Valve replacement is accomplished with homografts or heterografts, either stented bioprosthetic valves or valved conduits. In a retrospective analysis of the Children's Hospital of Wisconsin experience with PVR, there was no difference in survival or freedom from reintervention between heterografts and homografts. Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann 15:27-33

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Section: Cardiac Magnetic Resonance Measurements As An Indication Formentioning

confidence: 99%

Section: Cardiac Magnetic Resonance Measurements As An Indication Formentioning

confidence: 99%

Section: Indications For Pvrmentioning

confidence: 99%

See 1 more Smart Citation

Timing and Technique of Pulmonary Valve Replacement in the Patient With Tetralogy of Fallot

Tweddell

Simpson

et al. 2012

Seminars in Thoracic and Cardiovascular Surgery: Pediatric Card

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“…This allows serial follow-up of biventricular function. Knauth et al showed that severe right ventricular dilatation and either left or right ventricular dysfunction assessed by CMR predicted major adverse clinical events [25].…”

mentioning

confidence: 99%

Diastolic dysfunction: a new additional criterion for optimal timing of pulmonary valve replacement in adult patient with tetralogy of Fallot?

Mulder

Vliegen

Wall

2008

Int J Cardiovasc Imaging

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“…Following surgical correction, many patients have moderate to severe pulmonary insufficiency (PI) with minimal or no residual pulmonary stenosis (PS). Chronic PI plays a pivotal role in right ventricular (RV) dilatation and dysfunction, following surgical repair of RV outflow tract (RVOT) obstruction (2)(3)(4)(5)(6)(7)(8). Most patients following surgical correction of TOF experience a prolonged asymptomatic phase.…”

Section: Introductionmentioning

confidence: 99%

CMR assessment of right ventricular function in patients with combined pulmonary stenosis and insufficiency after correction of tetralogy of Fallot

et al. 2013

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Background: Tetralogy of Fallot (TOF) is one of the most common types of congenital heart disease and requires prompt surgical correction. Post-correction pulmonary insufficiency (PI) often ensues in adulthood. At times, the PI is accompanied by residual pulmonary stenosis (PS). Little is known regarding right ventricular (RV) function in the setting of combined PS and PI. Purpose: To compare cardiac magnetic resonance (CMR) parameters for the assessment of RV function between patients with combined pulmonary stenosis and pulmonary insufficiency (PSPI) and isolated PI following surgical repair of TOF. Material and Methods: Retrospective review of patients with comparable corrected TOF and similar PI was performed. Seventeen patients (median age, 24 years; range, 10-52 years) had combined PSPI and 30 patients (median age, 30 years; range, 6-70 years) had isolated PI. Cine magnetic resonance (MR) images (Philips Medical Systems, Best, The Netherlands) in the short-axis plane were used to calculate end-systolic, end-diastolic, and stroke volumes (RVESV, RVEDV, RVSV) and to measure RV wall thickness. Velocity-encoded cine MR images were used to measure pulmonary regurgitation fraction (PRF) by calculating the ratio of backward flow and total forward flow, obtained from the main pulmonary flow analysis. Peak pressure gradient across the pulmonary valve was obtained from spectral Doppler echocardiography. Results: RVEF was 51 AE 8% in the PSPI patients and 39 AE 11%, in the patients with isolated PI (P ¼ 0.001). Additionally, RV wall thickness was 5.2 AE 0.8 mm in the PSPI patients compared to 2.6 AE 0.9 mm in the isolated PI patients (P ¼ 0.001). RVESVi and RVEDVi were significantly lower (P < 0.05) in patients with combined PSPI (60 AE 21 mL/m 2 , 121 AE 35 mL/m 2 , respectively) compared to the patients with isolated PI (95 AE 48 mL/m 2 , 152 AE 61 mL/m 2 , respectively). Conclusion: RV function is preserved in patients with PSPI when compared to patients with PI following surgical repair of TOF.

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Ventricular size and function assessed by cardiac MRI predict major adverse clinical outcomes late after tetralogy of Fallot repair

Abstract: In this cohort, severe RV dilatation and either LV or RV dysfunction assessed by CMR predicted major adverse clinical events. This information may guide risk stratification and therapeutic interventions.

Cited by 451 publications

References 29 publications

Timing and Technique of Pulmonary Valve Replacement in the Patient With Tetralogy of Fallot

Timing and Technique of Pulmonary Valve Replacement in the Patient With Tetralogy of Fallot

Diastolic dysfunction: a new additional criterion for optimal timing of pulmonary valve replacement in adult patient with tetralogy of Fallot?

CMR assessment of right ventricular function in patients with combined pulmonary stenosis and insufficiency after correction of tetralogy of Fallot

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