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Restrictive versus nonrestrictive physiology following repair of tetralogy of Fallot: is there a difference?
J Am Soc Echocardiogr. 2013 Jul; 26(7):746-55.JA

Abstract

BACKGROUND

Long-term outcome in repaired tetralogy of Fallot (TOF) is related to chronic pulmonary insufficiency (PI), right ventricular (RV) dilation, and deterioration of RV function. The aim of this study was to characterize clinical differences between restrictive and nonrestrictive RV physiology in young patients with repaired TOF.

METHODS

Patients were prospectively enrolled from February 2008 to August 2009. Each had a clinic visit, brain natriuretic peptide assessment, exercise test, cardiac magnetic resonance study, and echocardiographic examination with assessment of regional myocardial mechanics. Consistent antegrade diastolic pulmonary arterial flow with atrial contraction identified restrictive RV physiology.

RESULTS

Twenty-nine patients (median age, 12 years; range, 8-33 years; nine male patients) were studied. Twelve had restrictive RV physiology. The median time since initial TOF repair was 12 years (range, 5-27 years). Restrictive physiology appeared more prevalent after transannular patch repair and was not influenced by other demographic features. The restrictive group had more PI (46% vs 28%, P = .002), larger RV end-diastolic volumes (128 vs 98 mL/m(2), P = .046), but similar ejection fractions, brain natriuretic peptide levels, New York Heart Association classes, and exercise capacity. RV basal and mid free wall peak diastolic strain rate differed between groups, negatively correlating with exercise time and positively correlating with PI in patients with restrictive physiology.

CONCLUSIONS

Restrictive RV physiology correlates with a larger right ventricle and increased PI after TOF repair but does not negatively affect other markers of myocardial health. Diastolic regional RV myocardial mechanics, particularly diastolic velocity and peak diastolic strain rate, differ for postoperative TOF patients with restrictive and nonrestrictive RV physiology; longitudinal study is necessary to understand the relationship of regional myocardial mechanics and patients' clinical status.

Authors+Show Affiliations

Department of Pediatrics, Division of Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA. msamyn@chw.orgNo affiliation info availableNo 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

Language

eng

PubMed ID

23623591

Citation

Samyn, Margaret M., et al. "Restrictive Versus Nonrestrictive Physiology Following Repair of Tetralogy of Fallot: Is There a Difference?" Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography, vol. 26, no. 7, 2013, pp. 746-55.
Samyn MM, Kwon EN, Gorentz JS, et al. Restrictive versus nonrestrictive physiology following repair of tetralogy of Fallot: is there a difference? J Am Soc Echocardiogr. 2013;26(7):746-55.
Samyn, M. M., Kwon, E. N., Gorentz, J. S., Yan, K., Danduran, M. J., Cava, J. R., Simpson, P. M., Frommelt, P. C., & Tweddell, J. S. (2013). Restrictive versus nonrestrictive physiology following repair of tetralogy of Fallot: is there a difference? Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography, 26(7), 746-55. https://doi.org/10.1016/j.echo.2013.03.019
Samyn MM, et al. Restrictive Versus Nonrestrictive Physiology Following Repair of Tetralogy of Fallot: Is There a Difference. J Am Soc Echocardiogr. 2013;26(7):746-55. PubMed PMID: 23623591.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Restrictive versus nonrestrictive physiology following repair of tetralogy of Fallot: is there a difference? AU - Samyn,Margaret M, AU - Kwon,Elena N, AU - Gorentz,Jessica S, AU - Yan,Ke, AU - Danduran,Michael J, AU - Cava,Joseph R, AU - Simpson,Pippa M, AU - Frommelt,Peter C, AU - Tweddell,James S, Y1 - 2013/04/25/ PY - 2011/06/30/received PY - 2013/4/30/entrez PY - 2013/4/30/pubmed PY - 2013/11/1/medline SP - 746 EP - 55 JF - Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography JO - J Am Soc Echocardiogr VL - 26 IS - 7 N2 - BACKGROUND: Long-term outcome in repaired tetralogy of Fallot (TOF) is related to chronic pulmonary insufficiency (PI), right ventricular (RV) dilation, and deterioration of RV function. The aim of this study was to characterize clinical differences between restrictive and nonrestrictive RV physiology in young patients with repaired TOF. METHODS: Patients were prospectively enrolled from February 2008 to August 2009. Each had a clinic visit, brain natriuretic peptide assessment, exercise test, cardiac magnetic resonance study, and echocardiographic examination with assessment of regional myocardial mechanics. Consistent antegrade diastolic pulmonary arterial flow with atrial contraction identified restrictive RV physiology. RESULTS: Twenty-nine patients (median age, 12 years; range, 8-33 years; nine male patients) were studied. Twelve had restrictive RV physiology. The median time since initial TOF repair was 12 years (range, 5-27 years). Restrictive physiology appeared more prevalent after transannular patch repair and was not influenced by other demographic features. The restrictive group had more PI (46% vs 28%, P = .002), larger RV end-diastolic volumes (128 vs 98 mL/m(2), P = .046), but similar ejection fractions, brain natriuretic peptide levels, New York Heart Association classes, and exercise capacity. RV basal and mid free wall peak diastolic strain rate differed between groups, negatively correlating with exercise time and positively correlating with PI in patients with restrictive physiology. CONCLUSIONS: Restrictive RV physiology correlates with a larger right ventricle and increased PI after TOF repair but does not negatively affect other markers of myocardial health. Diastolic regional RV myocardial mechanics, particularly diastolic velocity and peak diastolic strain rate, differ for postoperative TOF patients with restrictive and nonrestrictive RV physiology; longitudinal study is necessary to understand the relationship of regional myocardial mechanics and patients' clinical status. SN - 1097-6795 UR - https://www.unboundmedicine.com/medline/citation/23623591/Restrictive_versus_nonrestrictive_physiology_following_repair_of_tetralogy_of_Fallot:_is_there_a_difference L2 - https://linkinghub.elsevier.com/retrieve/pii/S0894-7317(13)00217-4 DB - PRIME DP - Unbound Medicine ER -