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Impact of surgical pulmonary valve replacement on ventricular mechanics in children with repaired tetralogy of Fallot.
Int J Cardiovasc Imaging. 2017 May; 33(5):711-720.IJ

Abstract

Impaired ventricular myocardial mechanics are observed in patients with repaired tetralogy of Fallot (rTOF). Effects of pulmonary valve replacement (PVR) on ventricular remodeling are controversial. The objective was to assess the impact of surgical PVR on ventricular mechanics in pediatric patients after rTOF. Speckle-tracking analysis was performed in 50 rTOF children, aged 12.6 ± 3.3 years, pre-operatively and 14.5 ± 2.2 months post-PVR. Early post-operative studies 2.2 ± 0.6 months post-PVR were performed in 28 patients. Cardiac magnetic resonance (CMR) pre- and post-PVR was collected. Mid-term post-PVR right ventricular (RV) longitudinal strain increased above pre-operative strain (-19.2 ± 2.7 to -22.0 ± 3.0%, p < 0.001) with increases observed in individual RV segments. Left ventricular (LV) strain did not differ at medium-term follow-up. LV and RV longitudinal strain was reduced early post-operatively, followed by recovery of biventricular systolic strain by mid-term follow-up. CMR RV end-diastolic indexed volumes correlated with RV strain pre-operatively (r = 0.432, p = 0.005) and at mid-term follow-up (r = 0.532, p = 0.001). Volume-loaded RVs had reduced early RV basal longitudinal strain compared to pressure-loading conditions. Reversed basal counterclockwise rotation was associated with lower mid-term global LV and basal RV strain compared to patients with normal rotation. An increase in mid-term global and regional RV strain beyond pre-operative values suggests positive RV remodeling and adaptation occurs in children post-PVR. Patients with larger pre-operative RV volumes had lower RV strain post-operatively. The impact of LV rotation on RV mechanics highlights the presence of ventriculo-ventricular interactions. These findings have important clinical implications in pediatric rTOF patients towards identifying pre-operative factors that predict RV post-operative remodeling.

Authors+Show Affiliations

The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. andreea.dragulescu@sickkids.ca.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28005218

Citation

Yim, D, et al. "Impact of Surgical Pulmonary Valve Replacement On Ventricular Mechanics in Children With Repaired Tetralogy of Fallot." The International Journal of Cardiovascular Imaging, vol. 33, no. 5, 2017, pp. 711-720.
Yim D, Mertens L, Morgan CT, et al. Impact of surgical pulmonary valve replacement on ventricular mechanics in children with repaired tetralogy of Fallot. Int J Cardiovasc Imaging. 2017;33(5):711-720.
Yim, D., Mertens, L., Morgan, C. T., Friedberg, M. K., Grosse-Wortmann, L., & Dragulescu, A. (2017). Impact of surgical pulmonary valve replacement on ventricular mechanics in children with repaired tetralogy of Fallot. The International Journal of Cardiovascular Imaging, 33(5), 711-720. https://doi.org/10.1007/s10554-016-1046-2
Yim D, et al. Impact of Surgical Pulmonary Valve Replacement On Ventricular Mechanics in Children With Repaired Tetralogy of Fallot. Int J Cardiovasc Imaging. 2017;33(5):711-720. PubMed PMID: 28005218.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of surgical pulmonary valve replacement on ventricular mechanics in children with repaired tetralogy of Fallot. AU - Yim,D, AU - Mertens,L, AU - Morgan,C T, AU - Friedberg,M K, AU - Grosse-Wortmann,L, AU - Dragulescu,A, Y1 - 2016/12/22/ PY - 2016/11/09/received PY - 2016/12/16/accepted PY - 2016/12/23/pubmed PY - 2017/10/3/medline PY - 2016/12/23/entrez KW - Myocardial deformation KW - PVR KW - Pulmonary valve replacement KW - Strain KW - TOF KW - Tetralogy of Fallot SP - 711 EP - 720 JF - The international journal of cardiovascular imaging JO - Int J Cardiovasc Imaging VL - 33 IS - 5 N2 - Impaired ventricular myocardial mechanics are observed in patients with repaired tetralogy of Fallot (rTOF). Effects of pulmonary valve replacement (PVR) on ventricular remodeling are controversial. The objective was to assess the impact of surgical PVR on ventricular mechanics in pediatric patients after rTOF. Speckle-tracking analysis was performed in 50 rTOF children, aged 12.6 ± 3.3 years, pre-operatively and 14.5 ± 2.2 months post-PVR. Early post-operative studies 2.2 ± 0.6 months post-PVR were performed in 28 patients. Cardiac magnetic resonance (CMR) pre- and post-PVR was collected. Mid-term post-PVR right ventricular (RV) longitudinal strain increased above pre-operative strain (-19.2 ± 2.7 to -22.0 ± 3.0%, p < 0.001) with increases observed in individual RV segments. Left ventricular (LV) strain did not differ at medium-term follow-up. LV and RV longitudinal strain was reduced early post-operatively, followed by recovery of biventricular systolic strain by mid-term follow-up. CMR RV end-diastolic indexed volumes correlated with RV strain pre-operatively (r = 0.432, p = 0.005) and at mid-term follow-up (r = 0.532, p = 0.001). Volume-loaded RVs had reduced early RV basal longitudinal strain compared to pressure-loading conditions. Reversed basal counterclockwise rotation was associated with lower mid-term global LV and basal RV strain compared to patients with normal rotation. An increase in mid-term global and regional RV strain beyond pre-operative values suggests positive RV remodeling and adaptation occurs in children post-PVR. Patients with larger pre-operative RV volumes had lower RV strain post-operatively. The impact of LV rotation on RV mechanics highlights the presence of ventriculo-ventricular interactions. These findings have important clinical implications in pediatric rTOF patients towards identifying pre-operative factors that predict RV post-operative remodeling. SN - 1875-8312 UR - https://www.unboundmedicine.com/medline/citation/28005218/Impact_of_surgical_pulmonary_valve_replacement_on_ventricular_mechanics_in_children_with_repaired_tetralogy_of_Fallot_ L2 - https://doi.org/10.1007/s10554-016-1046-2 DB - PRIME DP - Unbound Medicine ER -