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Sequential Right and Left Ventricular Assessment in Posttetralogy of Fallot Patients with Significant Pulmonary Regurgitation.
Congenit Heart Dis. 2016 Dec; 11(6):606-614.CH

Abstract

BACKGROUND

The natural history of right ventricular (RV) and left ventricular (LV) size and function among adults with tetralogy of Fallot (TOF) repair and hemodynamically significant pulmonary regurgitation (PR) is not known. The main aim of this study was to determine changes in RV and LV size and function over time in an adult population with TOF repair and hemodynamically significant pulmonary regurgitation.

METHODS

Forty patients with repaired TOF and hemodynamically significant PR were included. These patients were identified on the basis of having more than one CMR between January 2008 and 2015. Patients with a prosthetic pulmonary valve or any cardiac intervention between CMR studies were excluded. Rate of progression (ROP) of RV dilation was determined for both indexed right ventricular end-systolic volume (RVESVi) and indexed right ventricular end-diastolic volume (RVEDVi), and calculated as the difference between the last and first volumes divided by the number of years between CMR#1 and CMR#2. Subjects were also divided into two groups based on the distribution of the ROP of RV dilation: Group I-rapid ROP (>50th percentile) and Group II-slower ROP (≤50th percentile).

RESULTS

The interval between CMR#1 and CMR#2 was 3.9 ± 1.7 years (range 1-8 years). We did find a significant change in RVEDVi and RVESVi over this time period, although the magnitude of change was small. Nine patients (23%) had a reduction in right ventricular ejection fraction (RVEF) by greater than 5%, 13 patients (33%) had an increase in RVEDVi by greater than 10 mL/m2 and seven patients (18%) had an increase in RVESVi by greater than 10 mL/m2 . Median ROP for RVEDVi was 1.8 (range -10.4 to 21.8) mL/(m2 year); RVESVi 1.1 (range -5.8 to 24.5) mL/(m2 year) and RVEF -0.5 (range -8 to 4)%/year. Patients with a rapid ROP had significantly larger RV volumes at the time of CMR#1 and lower RVEF as compared to the slow ROP group. There was no overall significant change in LVEDVi, LVESVi, or LVEF over this time period.

CONCLUSIONS

We have demonstrated, in a small population of patients with hemodynamically significant PR, that there is a small increase in RV volumes and decrease in RVEF over a mean 4-year period. We believe it to be reasonable practice to perform CMR at least every 4 years in asymptomatic patients with repaired TOF and hemodynamically significant PR. We found that LV volumes and function remained stable during the study period, suggesting that significant progressive LV changes are less likely to occur over a shorter time period. Our results inform a safe standardized approach to monitoring adults with hemodynamically significant PR post TOF repair and assist in planning allocation of this expensive and limited resource.

Authors+Show Affiliations

Pacific Adult Congenital Heart Service, Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada.Department of Cardiac Imaging, St. Paul's Hospital, University of British Columbia, Vancouver, Canada.Department of Cardiac Imaging, St. Paul's Hospital, University of British Columbia, Vancouver, Canada.Department of Cardiac Imaging, St. Paul's Hospital, University of British Columbia, Vancouver, Canada.Pacific Adult Congenital Heart Service, Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada.Department of Cardiac Imaging, St. Paul's Hospital, University of British Columbia, Vancouver, Canada.Pacific Adult Congenital Heart Service, Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27225732

Citation

Wijesekera, Vishva A., et al. "Sequential Right and Left Ventricular Assessment in Posttetralogy of Fallot Patients With Significant Pulmonary Regurgitation." Congenital Heart Disease, vol. 11, no. 6, 2016, pp. 606-614.
Wijesekera VA, Raju R, Precious B, et al. Sequential Right and Left Ventricular Assessment in Posttetralogy of Fallot Patients with Significant Pulmonary Regurgitation. Congenit Heart Dis. 2016;11(6):606-614.
Wijesekera, V. A., Raju, R., Precious, B., Berger, A. J., Kiess, M. C., Leipsic, J. A., & Grewal, J. (2016). Sequential Right and Left Ventricular Assessment in Posttetralogy of Fallot Patients with Significant Pulmonary Regurgitation. Congenital Heart Disease, 11(6), 606-614. https://doi.org/10.1111/chd.12354
Wijesekera VA, et al. Sequential Right and Left Ventricular Assessment in Posttetralogy of Fallot Patients With Significant Pulmonary Regurgitation. Congenit Heart Dis. 2016;11(6):606-614. PubMed PMID: 27225732.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sequential Right and Left Ventricular Assessment in Posttetralogy of Fallot Patients with Significant Pulmonary Regurgitation. AU - Wijesekera,Vishva A, AU - Raju,Rekha, AU - Precious,Bruce, AU - Berger,Adam J, AU - Kiess,Marla C, AU - Leipsic,Jonathon A, AU - Grewal,Jasmine, Y1 - 2016/05/26/ PY - 2016/5/27/pubmed PY - 2017/3/28/medline PY - 2016/5/27/entrez KW - Cardiac Magnetic Resonance Imaging KW - Left Ventricle KW - Pulmonary Regurgitation KW - Right Ventricle KW - Tetralogy of Fallot SP - 606 EP - 614 JF - Congenital heart disease JO - Congenit Heart Dis VL - 11 IS - 6 N2 - BACKGROUND: The natural history of right ventricular (RV) and left ventricular (LV) size and function among adults with tetralogy of Fallot (TOF) repair and hemodynamically significant pulmonary regurgitation (PR) is not known. The main aim of this study was to determine changes in RV and LV size and function over time in an adult population with TOF repair and hemodynamically significant pulmonary regurgitation. METHODS: Forty patients with repaired TOF and hemodynamically significant PR were included. These patients were identified on the basis of having more than one CMR between January 2008 and 2015. Patients with a prosthetic pulmonary valve or any cardiac intervention between CMR studies were excluded. Rate of progression (ROP) of RV dilation was determined for both indexed right ventricular end-systolic volume (RVESVi) and indexed right ventricular end-diastolic volume (RVEDVi), and calculated as the difference between the last and first volumes divided by the number of years between CMR#1 and CMR#2. Subjects were also divided into two groups based on the distribution of the ROP of RV dilation: Group I-rapid ROP (>50th percentile) and Group II-slower ROP (≤50th percentile). RESULTS: The interval between CMR#1 and CMR#2 was 3.9 ± 1.7 years (range 1-8 years). We did find a significant change in RVEDVi and RVESVi over this time period, although the magnitude of change was small. Nine patients (23%) had a reduction in right ventricular ejection fraction (RVEF) by greater than 5%, 13 patients (33%) had an increase in RVEDVi by greater than 10 mL/m2 and seven patients (18%) had an increase in RVESVi by greater than 10 mL/m2 . Median ROP for RVEDVi was 1.8 (range -10.4 to 21.8) mL/(m2 year); RVESVi 1.1 (range -5.8 to 24.5) mL/(m2 year) and RVEF -0.5 (range -8 to 4)%/year. Patients with a rapid ROP had significantly larger RV volumes at the time of CMR#1 and lower RVEF as compared to the slow ROP group. There was no overall significant change in LVEDVi, LVESVi, or LVEF over this time period. CONCLUSIONS: We have demonstrated, in a small population of patients with hemodynamically significant PR, that there is a small increase in RV volumes and decrease in RVEF over a mean 4-year period. We believe it to be reasonable practice to perform CMR at least every 4 years in asymptomatic patients with repaired TOF and hemodynamically significant PR. We found that LV volumes and function remained stable during the study period, suggesting that significant progressive LV changes are less likely to occur over a shorter time period. Our results inform a safe standardized approach to monitoring adults with hemodynamically significant PR post TOF repair and assist in planning allocation of this expensive and limited resource. SN - 1747-0803 UR - https://www.unboundmedicine.com/medline/citation/27225732/Sequential_Right_and_Left_Ventricular_Assessment_in_Posttetralogy_of_Fallot_Patients_with_Significant_Pulmonary_Regurgitation_ L2 - https://doi.org/10.1111/chd.12354 DB - PRIME DP - Unbound Medicine ER -