Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-23T05:49:31.817Z Has data issue: false hasContentIssue false
  • English
  • Français

Right ventricular diastolic function after repair of tetralogy of Fallot: its relationship to the insertion of a ‘transannular’ patch

Published online by Cambridge University Press:  19 August 2008

Ayşe Güler Eročlu ,
Ayse Sarioşlu  and
Tayyar Sariočlu
Ayşe Güler Eročlu*
Affiliation:
Division of Pediatric Cardiology, Istanbul University Institute of Cardiology, Istanbul, Turkey
Ayse Sarioşlu
Affiliation:
Division of Pediatric Cardiology, Istanbul University Institute of Cardiology, Istanbul, Turkey
Tayyar Sariočlu
Affiliation:
Department of Cardiovascular Surgery, Istanbul University Institute of Cardiology, Istanbul, Turkey
*
Ayse G ler Eroglu, MD, Istanbul University Institute of Cardiology, 34304, Haseki, Istanbul, Turkey. Tel: +90 (212) 5896268; Fax: +90 (212) 5294262.
Get access Rights & Permissions [Opens in a new window]

Abstract

Examined was the effect of surgical technique, particularly the insertion of a transannular patch, on right ventricular diastolic function, and the relationship of forward flow in the pulmonary arteries during late diastole to right ventricular diastolic function in patients with tetralogy of Fallot. Transtricuspid, superior caval venous and pulmonary arterial Doppler spectrals were obtained and compared between 44 patients who had been repaired with a transannular patch; 14 patients who had been repaired with muscular resection and/or pulmonary valvotomy; six who had been repaired with an infundubular patch; and 32 normal children. The velocities of forward flow during late diastole in the pulmonary arteries of normal children ranged from 19.8 to 29.4 cm s−1 (mean 24.9 ± 2.8 cm s−1) throughout the respiratory cycle. Restrictive right ventricular physiology, defined on the basis of increased forward flow in the pulmonary arteries during late diastole (> 30 cm s−1) was present in 25 (57°) of 44 patients with tetralogy of Fallot repaired using a transannular patch. Right ventricular volume was 50.1 ± 23.7 cm3 in patients with a restrictive right ventricle and 64.9 ± 21.4 cm3 in patients in whom the ventricle was non-restrictive (p < 0.03). QRS duration was 140 ± 18 and 156 ± 24 ms in patients with restrictive and non-restrictive right ventricular physiology respectively (p < 0.003). Restrictive physiology was not encountered in patients with tetralogy in whom the pulmonary valve had been preserved. It is concluded that right ventricular restriction is present in many patients with tetralogy of Fallot at mid-term follow-up subsequent to repair using a ‘transannular’ patch. Restriction is associated with smaller right ventricular size and less prolongation of the QRS complex.

Keywords

Tetralogy of Fallotdiastoleechocardiographyventricles
Type
Original Articles
Information
Cardiology in the Young , Volume 9 , Issue 4 , July 1999 , pp. 384 - 391
Copyright
Copyright © Cambridge University Press 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Kirklin, JW, Blackstone, EH. Editorial on papers by Naito, Wessel and their Colleagues. J Thorac Cardiovasc Surg 1980; 80: 594–599.CrossRefGoogle ScholarPubMed
2.Touati, GD, Vouhe, PR, Amodeo, A, Pouard, P, Mauriat, P, Leca, F, Neveux, JY. Primary repair of tetralogy of Fallot in infancy. J Thorac Cardiovasc Surg 1990; 99: 396–402.CrossRefGoogle ScholarPubMed
3.Di, Donate RM, Jonas, RA, Lang, P, Rome, JJ, Mayer, JE, Castaneda, AR. Neonatal repair of tetralogy of Fallot with and without pulmonary atresia. J Thorac Cardiovasc Surg 1991; 101: 126–137.Google Scholar
4.Bove, EL, Byrum, CJ, Thomas, FD, Kavey, RE, Sondheimer, HM, Blackman, MS, Parker, FB. The influence of pulmonary insufficiency on ventricular function following repair of tetralogy of Fallot: evaluation using radionuclide ventriculography. J Thorac Cardiovasc Surg 1983; 85: 691–696.CrossRefGoogle ScholarPubMed
5.Oku, H, Shirotani, H, Sunakawa, A, Yokoyama, T. Postoperative long-term results in total correction of tetralogy of Fallot: hemodynamics and cardiac function. Ann Thorac Surg 1986; 41: 413–418.CrossRefGoogle ScholarPubMed
6.Vick, GW, Server, GA. Echocardiographic evaluation of the postoperative tetralogy of Fallot patient. Circulation 1978; 58: 842–849.CrossRefGoogle ScholarPubMed
7.Graham, TP, Cordell, D, Atwood, GF, Boucek, RJ, Boerth, RC, Bender, HW, Nelson, JH, Vaughn, WK. Right ventricular volume characteristics before and after palliative and reparative operation in tetralogy of Fallot. Circulation 1976; 54: 417–423.CrossRefGoogle ScholarPubMed
8.Wessel, HU, Cunningham, WJ, Paul, MH, Bastanier, CK, Muster, AJ, Idris, FS. Exercise performance in tetralogy of Fallot after intracardiac repair. J Thorac Cardiovasc Surg 1980; 80: 582–593.CrossRefGoogle ScholarPubMed
9.Dietl, CA, Cazzaniga, ME, Dubner, SJ, Perez-Balino, NA, Torres, AR, Favaloro, RG. Life-threatening arrhythmias and RV dysfunction after surgical repair of tetralogy of Fallot: comparison between transventricular and transatrial approaches. Circulation 1994; 90: II–7–12.Google ScholarPubMed
10.Gatzoulis, MA, Clark, AL, Cullen, S, Newman, CG, Redington, AN. Right ventricular diastolic function 15 to 35 years after repair of tetralogy of Fallot: restrictive physiology predicts superior exercise performance. Circulation 1995; 91: 1775–1781.CrossRefGoogle ScholarPubMed
11.Onat, T. Influence of the respiratory cycle on the configuration of the heart and vessels in the chest X-rays of children. Cardiology 1971; 55: 281–301.CrossRefGoogle ScholarPubMed
12.Isobe, M, Yazaki, Y, Takaku, F, Hara, K, Kashida, M, Yamaguchi, T, Machii, K. Right ventricular filling detected by pulsed-Doppler echocardiography during the convalescent stage of inferior wall acute myocardial infarction. Am J Cardiol 1987; 59: 1245–1250.CrossRefGoogle ScholarPubMed
13.Zoghbi, WA, Habib, GB, Quinones, MA. Doppler assessment of right ventricular filling in a normal population: comparison with left ventricular filling dynamics. Circulation 1990; 82: 1316–1324.CrossRefGoogle Scholar
14.Cullen, S, Shore, D, Redington, A. Characterization of right ventricular performance after repair of tetralogy of Fallot: restrictive physiology predicts slow postoperative recovery. Circulation 1995; 91: 1782–1789.CrossRefGoogle ScholarPubMed
15.Norgard, G, Gatzoulis, MA, Moraes, F, Lincoln, C, Shore, DF, Shinebourne, EA, Redington, AN. Relationship between type of outflow tract repair and postoperative right ventricular diastolic physiology in tetralogy of Fallot: implications for long-term outcome. Circulation 1996; 94: 3276–3280.CrossRefGoogle ScholarPubMed
16.Helbing, WA, Niezen, RA, Le Cessie, S, van, der Geest RJ, Ottenkamp, J, de, Roos A. Right ventricular diastolic function in children with pulmonary regurgitation after repair of tetralogy of Fallot: volumetric evaluation by magnetic resonance velocity mapping. J Am Coll Cardiol 1996; 28: 1827–1835.CrossRefGoogle ScholarPubMed
17.Nishimura, RA, Abel, MD, Hattle, LK, Tajik, AJ. Assessment of diastolic function of the heart: background and current applications of Doppler echocardiography. Part 2. Clinical studies. Mayo Clin Proc 1989; 64: 181–204.CrossRefGoogle Scholar
18.Gibbs, JL, Wilson, N, Witsenburg, M, Williams, GJ, Goldberg, SJ. Diastolic forward flow in the pulmonary artery detected by Doppler echocardiography. J Am Coll Cardiol 1985; 6: 1322–1328.CrossRefGoogle ScholarPubMed
19.Gatzoulis, MA, Till, JA, Somerville, J, Redington, AN. Mechanoelectrical interaction in tetralogy of Fallot: QRS prolongation relates to right ventricular size and predicts malignant ventricular arrhythmias and sudden death. Circulation 1995; 92: 231–237.CrossRefGoogle ScholarPubMed
20.Fuster, V, McGoon, DC, Kennedy, MA, Ritter, DG, Kirklin, JW. Long-term evaluation (12 to 22 years) of open heart surgery for tetralogy of Fallot. Am J Cardiol 1980; 46: 635–642.CrossRefGoogle ScholarPubMed
21.Murphy, JG, Gersh, BJ, Mair, DD, Fuster, V, McGoon, MD, Ilstrup, DM, McGoon, DC, Kirklin, JW, Danielson, GK. Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot. N Engl J Med 1993; 329: 593–599.CrossRefGoogle ScholarPubMed
22.Redington, AN, Oldershaw, PJ, Shinebourne, EA, Rigby, ML. A new technique for the assessment of pulmonary regurgitation and its application to the assessment of right ventricular function before and after repair of tetralogy of Fallot. Br Heart J 1988; 60: 57–65.CrossRefGoogle Scholar