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Vicious circle between progressive right ventricular dilatation and pulmonary regurgitation in patients after tetralogy of Fallot repair? Right heart enlargement promotes flow reversal in the left pulmonary artery.
J Cardiovasc Magn Reson. 2016 06 07; 18(1):34.JC

Abstract

BACKGROUND

The left pulmonary artery (LPA) contributes more than the right (RPA) to total pulmonary regurgitation (PR) in patients after tetralogy of Fallot (TOF) repair, but the mechanism of this difference is not well understood. This study aimed to analyze the interplay between heart and lung size, mediastinal geometry, and differential PR.

METHODS

Forty-eight Cardiovascular Magnetic Resonance (CMR) studies in patients after TOF repair were analyzed. In addition to the routine blood flow and ventricular volume quantification cardiac angle between the thoracic anterior-posterior line and the interventricular septum, right and left lung areas as well as right and left hemithorax areas were measured on an axial image. Statistical analysis was performed to compare flow parameters between RPA and LPA and to assess correlation among right ventricular volume, pulmonary blood flow parameters and lung area.

RESULTS

There was no difference between LPA and RPA diameters. The LPA showed significantly less total forward flow (2.49 ± 0.87 L/min/m(2) vs 2.86 ± 0.89 L/min/m(2); p = 0.02), smaller net forward flow (1.40 ± 0.51 vs 1.89 ± 0.60 mL/min/m(2); p = <0.001), and greater regurgitant fraction (RF) (34 ± 10 % vs 43 ± 12 %; p = 0.001) than the RPA. There was no difference in regurgitant flow volume between RPA and LPA (p = 0.29). Indexed right ventricular end-diastolic volume (RVEDVi) correlated with LPA RF (R = 0.48, p < 0.001), but not with RPA RF (p = 0.09). Larger RVEDVi correlated with a more leftward cardiac axis (R = 0.46, p < 0.001) and with smaller left lung area (R = -0.58, p < 0.001). LPA RF, but not RPA RF, correlated inversely with left lung area (R = -0.34, p = 0.02). The follow-up CMRs in 20 patients showed a correlation of the rate of RV enlargement with the rates of LPA RF worsening (R = 0.50, p = 0.03), and of increasing left lung compression (R = -0.55, p = 0.012).

CONCLUSION

An enlarged and levorotated heart is associated with left lung compression and impaired flow into the left lung.

Authors+Show Affiliations

Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, M5G 1X8, ON, Canada.Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, M5G 1X8, ON, Canada. now: Université Laval, Quebec City, QC, Canada.Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, M5G 1X8, ON, Canada. Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, M5G 1X8, ON, Canada. now: Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA.Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, M5G 1X8, ON, Canada. lars.grosse-wortmann@sickkids.ca. Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. lars.grosse-wortmann@sickkids.ca.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27268132

Citation

Kato, Atsuko, et al. "Vicious Circle Between Progressive Right Ventricular Dilatation and Pulmonary Regurgitation in Patients After Tetralogy of Fallot Repair? Right Heart Enlargement Promotes Flow Reversal in the Left Pulmonary Artery." Journal of Cardiovascular Magnetic Resonance : Official Journal of the Society for Cardiovascular Magnetic Resonance, vol. 18, no. 1, 2016, p. 34.
Kato A, Drolet C, Yoo SJ, et al. Vicious circle between progressive right ventricular dilatation and pulmonary regurgitation in patients after tetralogy of Fallot repair? Right heart enlargement promotes flow reversal in the left pulmonary artery. J Cardiovasc Magn Reson. 2016;18(1):34.
Kato, A., Drolet, C., Yoo, S. J., Redington, A. N., & Grosse-Wortmann, L. (2016). Vicious circle between progressive right ventricular dilatation and pulmonary regurgitation in patients after tetralogy of Fallot repair? Right heart enlargement promotes flow reversal in the left pulmonary artery. Journal of Cardiovascular Magnetic Resonance : Official Journal of the Society for Cardiovascular Magnetic Resonance, 18(1), 34. https://doi.org/10.1186/s12968-016-0254-1
Kato A, et al. Vicious Circle Between Progressive Right Ventricular Dilatation and Pulmonary Regurgitation in Patients After Tetralogy of Fallot Repair? Right Heart Enlargement Promotes Flow Reversal in the Left Pulmonary Artery. J Cardiovasc Magn Reson. 2016 06 7;18(1):34. PubMed PMID: 27268132.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vicious circle between progressive right ventricular dilatation and pulmonary regurgitation in patients after tetralogy of Fallot repair? Right heart enlargement promotes flow reversal in the left pulmonary artery. AU - Kato,Atsuko, AU - Drolet,Christian, AU - Yoo,Shi-Joon, AU - Redington,Andrew N, AU - Grosse-Wortmann,Lars, Y1 - 2016/06/07/ PY - 2016/02/11/received PY - 2016/05/25/accepted PY - 2016/6/9/entrez PY - 2016/6/9/pubmed PY - 2017/11/14/medline KW - Cardiovascular magnetic resonance KW - Differential pulmonary blood flow KW - Pulmonary regurgitation KW - Right ventricular enlargement KW - Tetralogy of Fallot SP - 34 EP - 34 JF - Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance JO - J Cardiovasc Magn Reson VL - 18 IS - 1 N2 - BACKGROUND: The left pulmonary artery (LPA) contributes more than the right (RPA) to total pulmonary regurgitation (PR) in patients after tetralogy of Fallot (TOF) repair, but the mechanism of this difference is not well understood. This study aimed to analyze the interplay between heart and lung size, mediastinal geometry, and differential PR. METHODS: Forty-eight Cardiovascular Magnetic Resonance (CMR) studies in patients after TOF repair were analyzed. In addition to the routine blood flow and ventricular volume quantification cardiac angle between the thoracic anterior-posterior line and the interventricular septum, right and left lung areas as well as right and left hemithorax areas were measured on an axial image. Statistical analysis was performed to compare flow parameters between RPA and LPA and to assess correlation among right ventricular volume, pulmonary blood flow parameters and lung area. RESULTS: There was no difference between LPA and RPA diameters. The LPA showed significantly less total forward flow (2.49 ± 0.87 L/min/m(2) vs 2.86 ± 0.89 L/min/m(2); p = 0.02), smaller net forward flow (1.40 ± 0.51 vs 1.89 ± 0.60 mL/min/m(2); p = <0.001), and greater regurgitant fraction (RF) (34 ± 10 % vs 43 ± 12 %; p = 0.001) than the RPA. There was no difference in regurgitant flow volume between RPA and LPA (p = 0.29). Indexed right ventricular end-diastolic volume (RVEDVi) correlated with LPA RF (R = 0.48, p < 0.001), but not with RPA RF (p = 0.09). Larger RVEDVi correlated with a more leftward cardiac axis (R = 0.46, p < 0.001) and with smaller left lung area (R = -0.58, p < 0.001). LPA RF, but not RPA RF, correlated inversely with left lung area (R = -0.34, p = 0.02). The follow-up CMRs in 20 patients showed a correlation of the rate of RV enlargement with the rates of LPA RF worsening (R = 0.50, p = 0.03), and of increasing left lung compression (R = -0.55, p = 0.012). CONCLUSION: An enlarged and levorotated heart is associated with left lung compression and impaired flow into the left lung. SN - 1532-429X UR - https://www.unboundmedicine.com/medline/citation/27268132/Vicious_circle_between_progressive_right_ventricular_dilatation_and_pulmonary_regurgitation_in_patients_after_tetralogy_of_Fallot_repair_Right_heart_enlargement_promotes_flow_reversal_in_the_left_pulmonary_artery_ L2 - https://jcmr-online.biomedcentral.com/articles/10.1186/s12968-016-0254-1 DB - PRIME DP - Unbound Medicine ER -