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Acute and chronic effects of dysfunction of right ventricular outflow tract components on right ventricular performance in a porcine model: implications for primary repair of tetralogy of fallot.
J Am Coll Cardiol. 2012 Jul 03; 60(1):64-71.JACC

Abstract

OBJECTIVES

This study investigates the contribution of infundibular versus pulmonary valve (PV) dysfunction on right ventricular (RV) function in a porcine model.

BACKGROUND

Clinical outcome after repair of tetralogy of Fallot is determined by the adaptation of the right ventricle to the physiological sequelae of the right ventricular outflow tract (RVOT) reconstruction. Recent surgical techniques are pursuing a PV-versus infundibulum-sparing approach.

METHODS

In a porcine model, 3 types of RVOT dysfunction were created and compared with sham-operated controls: infundibular dysfunction (INF), PV insufficiency (PI), and combined infundibular-PV dysfunction (TAP). Both acute and chronic effects on RV function were studied by using conductance technology and magnetic resonance imaging.

RESULTS

In animals with PI, pulmonary regurgitant fraction progressed more in the presence of concomitant INF (54% in TAP versus 14% in PI; p = 0.03). Subsequently, RV end-systolic and end-diastolic volume increased more in both groups, resulting in decreased ejection fraction after 3 months. Preload-independent systolic indices showed acute impairment of RV contractility in all treatment groups but most in animals with infundibular scarring (INF and TAP). Further chronic deterioration was observed in animals of the TAP group. RV compliance improved proportionally most in the PI and TAP groups in relation to the extent of RV dilation.

CONCLUSIONS

Surgical RVOT dysfunction, whether it includes the infundibulum and/or the PV, has an immediate effect on RV performance. Although impaired RV contractility is due to intrinsic myocardial damage by infundibular distortion, it is chronically furthered by PI-related RV dilation. These findings support the adoption of a RVOT-sparing strategy to treat tetralogy of Fallot.

Authors+Show Affiliations

Department of Cardiac Surgery, University Hospital of Ghent, Ghent, Belgium. thierry.bove@ugent.beNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22742402

Citation

Bove, Thierry, et al. "Acute and Chronic Effects of Dysfunction of Right Ventricular Outflow Tract Components On Right Ventricular Performance in a Porcine Model: Implications for Primary Repair of Tetralogy of Fallot." Journal of the American College of Cardiology, vol. 60, no. 1, 2012, pp. 64-71.
Bove T, Bouchez S, De Hert S, et al. Acute and chronic effects of dysfunction of right ventricular outflow tract components on right ventricular performance in a porcine model: implications for primary repair of tetralogy of fallot. J Am Coll Cardiol. 2012;60(1):64-71.
Bove, T., Bouchez, S., De Hert, S., Wouters, P., De Somer, F., Devos, D., Somers, P., & Van Nooten, G. (2012). Acute and chronic effects of dysfunction of right ventricular outflow tract components on right ventricular performance in a porcine model: implications for primary repair of tetralogy of fallot. Journal of the American College of Cardiology, 60(1), 64-71. https://doi.org/10.1016/j.jacc.2012.03.035
Bove T, et al. Acute and Chronic Effects of Dysfunction of Right Ventricular Outflow Tract Components On Right Ventricular Performance in a Porcine Model: Implications for Primary Repair of Tetralogy of Fallot. J Am Coll Cardiol. 2012 Jul 3;60(1):64-71. PubMed PMID: 22742402.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute and chronic effects of dysfunction of right ventricular outflow tract components on right ventricular performance in a porcine model: implications for primary repair of tetralogy of fallot. AU - Bove,Thierry, AU - Bouchez,Stefaan, AU - De Hert,Stefan, AU - Wouters,Patrick, AU - De Somer,Filip, AU - Devos,Daniel, AU - Somers,Pamela, AU - Van Nooten,Guido, PY - 2011/12/19/received PY - 2012/02/19/revised PY - 2012/03/19/accepted PY - 2012/6/30/entrez PY - 2012/6/30/pubmed PY - 2012/9/1/medline SP - 64 EP - 71 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 60 IS - 1 N2 - OBJECTIVES: This study investigates the contribution of infundibular versus pulmonary valve (PV) dysfunction on right ventricular (RV) function in a porcine model. BACKGROUND: Clinical outcome after repair of tetralogy of Fallot is determined by the adaptation of the right ventricle to the physiological sequelae of the right ventricular outflow tract (RVOT) reconstruction. Recent surgical techniques are pursuing a PV-versus infundibulum-sparing approach. METHODS: In a porcine model, 3 types of RVOT dysfunction were created and compared with sham-operated controls: infundibular dysfunction (INF), PV insufficiency (PI), and combined infundibular-PV dysfunction (TAP). Both acute and chronic effects on RV function were studied by using conductance technology and magnetic resonance imaging. RESULTS: In animals with PI, pulmonary regurgitant fraction progressed more in the presence of concomitant INF (54% in TAP versus 14% in PI; p = 0.03). Subsequently, RV end-systolic and end-diastolic volume increased more in both groups, resulting in decreased ejection fraction after 3 months. Preload-independent systolic indices showed acute impairment of RV contractility in all treatment groups but most in animals with infundibular scarring (INF and TAP). Further chronic deterioration was observed in animals of the TAP group. RV compliance improved proportionally most in the PI and TAP groups in relation to the extent of RV dilation. CONCLUSIONS: Surgical RVOT dysfunction, whether it includes the infundibulum and/or the PV, has an immediate effect on RV performance. Although impaired RV contractility is due to intrinsic myocardial damage by infundibular distortion, it is chronically furthered by PI-related RV dilation. These findings support the adoption of a RVOT-sparing strategy to treat tetralogy of Fallot. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/22742402/Acute_and_chronic_effects_of_dysfunction_of_right_ventricular_outflow_tract_components_on_right_ventricular_performance_in_a_porcine_model:_implications_for_primary_repair_of_tetralogy_of_fallot_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(12)01326-5 DB - PRIME DP - Unbound Medicine ER -