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Impact of pressure load caused by right ventricular outflow tract obstruction on right ventricular volume overload in patients with repaired tetralogy of Fallot.
J Thorac Cardiovasc Surg. 2012 Jun; 143(6):1299-304.JT

Abstract

OBJECTIVES

In correction of tetralogy of Fallot (TOF), surgical strategies to minimize right ventricular outflow tract (RVOT) enlargement have recently been preferred. However, we may be confronted with residual pulmonary stenosis (PS) combined with pulmonary regurgitation (PR), and how the pressure load affects these patients is not evident.

METHODS

We compared 51 patients with PR and significant PS (PR with PS group) with 87 patients with PR without significant PS (PR group) using echocardiography and cardiac magnetic imaging. We evaluated the differences in parameters derived by magnetic resonance imaging between the 2 groups and the influence of the pressure load on right ventricular (RV) volume and function.

RESULTS

Although the PR fraction was similar between the 2 groups, the PR with PS group showed significantly smaller RV end-diastolic volume (136.7 ± 26.5 mL/m(2) vs 151.2 ± 34.7 mL/m(2); P = .01), RV end-systolic volume (68.1 ± 23.7 mL/m(2) vs 80.2 ± 27.5 mL/m(2); P = .01), and slightly better RV ejection fraction (51.1% ± 9.8% vs 47.6% ± 8.9%; P = .03) than the PR group. For influence of the pressure load, PR fraction (r = -0.18, P = .03), RV end-diastolic volume (r = -0.25, P = .003), and RV end-systolic volume (r = -0.24, P = .005) were decreased as peak pressure gradient of PS was higher. Linear regression analysis revealed that both PR fraction and peak pressure gradient of PS were independent predictors for RV volume.

CONCLUSIONS

Our study demonstrated that the RV pressure load prevented RV dilatation from chronic PR without systolic dysfunction. It is suggested that a proper relief of RVOT obstruction with acceptable residual stenosis is more advantageous than aggressive RVOT enlargement in the long-term outcome of repaired TOF.

Authors+Show Affiliations

Division of Pediatric Cardiology, Yonsei University College of Medicine, Seoul, Korea. bwyoo@yuhs.acNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22244553

Citation

Yoo, Byung Won, et al. "Impact of Pressure Load Caused By Right Ventricular Outflow Tract Obstruction On Right Ventricular Volume Overload in Patients With Repaired Tetralogy of Fallot." The Journal of Thoracic and Cardiovascular Surgery, vol. 143, no. 6, 2012, pp. 1299-304.
Yoo BW, Kim JO, Kim YJ, et al. Impact of pressure load caused by right ventricular outflow tract obstruction on right ventricular volume overload in patients with repaired tetralogy of Fallot. J Thorac Cardiovasc Surg. 2012;143(6):1299-304.
Yoo, B. W., Kim, J. O., Kim, Y. J., Choi, J. Y., Park, H. K., Park, Y. H., & Sul, J. H. (2012). Impact of pressure load caused by right ventricular outflow tract obstruction on right ventricular volume overload in patients with repaired tetralogy of Fallot. The Journal of Thoracic and Cardiovascular Surgery, 143(6), 1299-304. https://doi.org/10.1016/j.jtcvs.2011.12.033
Yoo BW, et al. Impact of Pressure Load Caused By Right Ventricular Outflow Tract Obstruction On Right Ventricular Volume Overload in Patients With Repaired Tetralogy of Fallot. J Thorac Cardiovasc Surg. 2012;143(6):1299-304. PubMed PMID: 22244553.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of pressure load caused by right ventricular outflow tract obstruction on right ventricular volume overload in patients with repaired tetralogy of Fallot. AU - Yoo,Byung Won, AU - Kim,Jung Ok, AU - Kim,Young Jin, AU - Choi,Jae Young, AU - Park,Han Ki, AU - Park,Young Hwan, AU - Sul,Jun Hee, Y1 - 2012/01/12/ PY - 2011/08/04/received PY - 2011/11/18/revised PY - 2011/12/14/accepted PY - 2012/1/17/entrez PY - 2012/1/17/pubmed PY - 2012/7/12/medline SP - 1299 EP - 304 JF - The Journal of thoracic and cardiovascular surgery JO - J. Thorac. Cardiovasc. Surg. VL - 143 IS - 6 N2 - OBJECTIVES: In correction of tetralogy of Fallot (TOF), surgical strategies to minimize right ventricular outflow tract (RVOT) enlargement have recently been preferred. However, we may be confronted with residual pulmonary stenosis (PS) combined with pulmonary regurgitation (PR), and how the pressure load affects these patients is not evident. METHODS: We compared 51 patients with PR and significant PS (PR with PS group) with 87 patients with PR without significant PS (PR group) using echocardiography and cardiac magnetic imaging. We evaluated the differences in parameters derived by magnetic resonance imaging between the 2 groups and the influence of the pressure load on right ventricular (RV) volume and function. RESULTS: Although the PR fraction was similar between the 2 groups, the PR with PS group showed significantly smaller RV end-diastolic volume (136.7 ± 26.5 mL/m(2) vs 151.2 ± 34.7 mL/m(2); P = .01), RV end-systolic volume (68.1 ± 23.7 mL/m(2) vs 80.2 ± 27.5 mL/m(2); P = .01), and slightly better RV ejection fraction (51.1% ± 9.8% vs 47.6% ± 8.9%; P = .03) than the PR group. For influence of the pressure load, PR fraction (r = -0.18, P = .03), RV end-diastolic volume (r = -0.25, P = .003), and RV end-systolic volume (r = -0.24, P = .005) were decreased as peak pressure gradient of PS was higher. Linear regression analysis revealed that both PR fraction and peak pressure gradient of PS were independent predictors for RV volume. CONCLUSIONS: Our study demonstrated that the RV pressure load prevented RV dilatation from chronic PR without systolic dysfunction. It is suggested that a proper relief of RVOT obstruction with acceptable residual stenosis is more advantageous than aggressive RVOT enlargement in the long-term outcome of repaired TOF. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/22244553/Impact_of_pressure_load_caused_by_right_ventricular_outflow_tract_obstruction_on_right_ventricular_volume_overload_in_patients_with_repaired_tetralogy_of_Fallot_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(11)01451-6 DB - PRIME DP - Unbound Medicine ER -