Tags

Type your tag names separated by a space and hit enter

Differential Impact of Pulmonary Regurgitation on Patients With Surgically Repaired Pulmonary Stenosis Versus Tetralogy of Fallot.
Am J Cardiol. 2016 Jan 15; 117(2):289-94.AJ

Abstract

Patients with repaired pulmonary stenosis (PS) or tetralogy of Fallot (TOF) both develop pulmonary regurgitation (PR) leading to right ventricular (RV) dilatation and dysfunction. We aimed to characterize differential effects of chronic PR in these populations. Patients with surgically repaired PS were matched 1:2 by age and PR fraction with patients with TOF. Patients with previous pulmonary valve replacement were excluded. Cardiovascular magnetic resonance data were compared; peak longitudinal and circumferential systolic strain by feature tracking were compared to evaluate differential contribution of the RV sinus and outflow tract, respectively. PS (n = 24, 41 ± 13 years old) and TOF (n = 47, 39 ± 13 years old) patients did not differ in RV end-diastolic volume (153 ± 45 vs 154 ± 45 ml/m(2), p = 0.99) or diastolic function. However, patients with PS had preserved RV ejection fraction (54.3 ± 4.4% vs 48.0 ± 7.1%, p <0.0001). Differences were greater in RV circumferential (-15.8 ± 3.3 vs -11.8 ± 3.4, p <0.0001) than longitudinal strain (-18.0 ± 3.8 vs -15.9 ± 3.8, p = 0.04), with particular decrease in the infundibulum (-17.4 ± 7.5 vs -6.8 ± 6.3, p <0.0001). Late gadolinium enhancement in the RV outflow tract was more frequent in patients with TOF (70.2% vs 45.8%, p = 0.001). In conclusion, surgical repair of PS leads to similar RV dilatation and diastolic dysfunction compared to patients with TOF, but differential effects on ventricular systolic function, largely related to differences in the outflow tract. With different patterns of scarring and ventricular remodeling, further study is needed to clarify whether criteria for pulmonary valve replacement in patients with PS should differ from those with TOF.

Authors+Show Affiliations

Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan. Electronic address: mjoynt@med.umich.edu.Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan.Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan; Section of Pediatric Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan.Section of Pediatric Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan; Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan.Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan.Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan; Section of Pediatric Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26651611

Citation

Joynt, Michael R., et al. "Differential Impact of Pulmonary Regurgitation On Patients With Surgically Repaired Pulmonary Stenosis Versus Tetralogy of Fallot." The American Journal of Cardiology, vol. 117, no. 2, 2016, pp. 289-94.
Joynt MR, Yu S, Dorfman AL, et al. Differential Impact of Pulmonary Regurgitation on Patients With Surgically Repaired Pulmonary Stenosis Versus Tetralogy of Fallot. Am J Cardiol. 2016;117(2):289-94.
Joynt, M. R., Yu, S., Dorfman, A. L., Ghadimi Mahani, M., Agarwal, P. P., & Lu, J. C. (2016). Differential Impact of Pulmonary Regurgitation on Patients With Surgically Repaired Pulmonary Stenosis Versus Tetralogy of Fallot. The American Journal of Cardiology, 117(2), 289-94. https://doi.org/10.1016/j.amjcard.2015.10.025
Joynt MR, et al. Differential Impact of Pulmonary Regurgitation On Patients With Surgically Repaired Pulmonary Stenosis Versus Tetralogy of Fallot. Am J Cardiol. 2016 Jan 15;117(2):289-94. PubMed PMID: 26651611.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Differential Impact of Pulmonary Regurgitation on Patients With Surgically Repaired Pulmonary Stenosis Versus Tetralogy of Fallot. AU - Joynt,Michael R, AU - Yu,Sunkyung, AU - Dorfman,Adam L, AU - Ghadimi Mahani,Maryam, AU - Agarwal,Prachi P, AU - Lu,Jimmy C, Y1 - 2015/11/05/ PY - 2015/07/09/received PY - 2015/10/22/revised PY - 2015/10/22/accepted PY - 2015/12/15/entrez PY - 2015/12/15/pubmed PY - 2016/5/11/medline SP - 289 EP - 94 JF - The American journal of cardiology JO - Am J Cardiol VL - 117 IS - 2 N2 - Patients with repaired pulmonary stenosis (PS) or tetralogy of Fallot (TOF) both develop pulmonary regurgitation (PR) leading to right ventricular (RV) dilatation and dysfunction. We aimed to characterize differential effects of chronic PR in these populations. Patients with surgically repaired PS were matched 1:2 by age and PR fraction with patients with TOF. Patients with previous pulmonary valve replacement were excluded. Cardiovascular magnetic resonance data were compared; peak longitudinal and circumferential systolic strain by feature tracking were compared to evaluate differential contribution of the RV sinus and outflow tract, respectively. PS (n = 24, 41 ± 13 years old) and TOF (n = 47, 39 ± 13 years old) patients did not differ in RV end-diastolic volume (153 ± 45 vs 154 ± 45 ml/m(2), p = 0.99) or diastolic function. However, patients with PS had preserved RV ejection fraction (54.3 ± 4.4% vs 48.0 ± 7.1%, p <0.0001). Differences were greater in RV circumferential (-15.8 ± 3.3 vs -11.8 ± 3.4, p <0.0001) than longitudinal strain (-18.0 ± 3.8 vs -15.9 ± 3.8, p = 0.04), with particular decrease in the infundibulum (-17.4 ± 7.5 vs -6.8 ± 6.3, p <0.0001). Late gadolinium enhancement in the RV outflow tract was more frequent in patients with TOF (70.2% vs 45.8%, p = 0.001). In conclusion, surgical repair of PS leads to similar RV dilatation and diastolic dysfunction compared to patients with TOF, but differential effects on ventricular systolic function, largely related to differences in the outflow tract. With different patterns of scarring and ventricular remodeling, further study is needed to clarify whether criteria for pulmonary valve replacement in patients with PS should differ from those with TOF. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/26651611/Differential_Impact_of_Pulmonary_Regurgitation_on_Patients_With_Surgically_Repaired_Pulmonary_Stenosis_Versus_Tetralogy_of_Fallot_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(15)02189-X DB - PRIME DP - Unbound Medicine ER -