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Abnormal aortic flow conduction is associated with increased viscous energy loss in patients with repaired tetralogy of Fallot.
Eur J Cardiothorac Surg. 2020 03 01; 57(3):588-595.EJ

Abstract

OBJECTIVES

Aortopathy in tetralogy of Fallot (TOF) is characterized by increased aortic stiffness, dilation and reduced left ventricular (LV) function. Repair in infancy normalizes aortic dimensions in early childhood. Our prior work demonstrated that early TOF repair does not normalize aortic compliance and that abnormal ascending aortic flow patterns are prevalent. The objectives of this study were to: (i) determine whether proximal aortic flow-mediated viscous energy loss (EL') is elevated in patients with early TOF repair compared with healthy controls, and (ii) determine whether the degree of EL' is associated with LV function.

METHODS

Forty-one patients post TOF repair with normalized aortic size and 15 healthy controls underwent 4-dimenisonal-flow magnetic resonance imaging flow analysis and EL' assessment. Correlations between EL', aortic size, and LV function were assessed.

RESULTS

The TOF group had increased peak systolic thoracic aorta EL' (3.8 vs 1.5 mW, P = 0.004) and increased averaged EL' throughout the cardiac cycle (1.2 vs 0.5 mW, P = 0.003). Peak and mean systolic EL' in the ascending aorta was increased 2-fold in the TOF group compared with control (peak: 2.0 vs 0.9 mW, P = 0.007). Peak EL' measured along the entire thoracic aortic length correlated with LV ejection fraction (R = -0.45, P = 0.009), indexed LV end-systolic volume (R = -0.40, P = 0.010), and right ventricular end-systolic volume (R = -0.37, P = 0.034).

CONCLUSIONS

Patients with repaired TOF exhibit abnormal aortic flow associated with increased EL' in the thoracic aorta. The magnitude of EL' is associated with LV function and volumes. Increased aortic EL' in TOF is likely due to inherently abnormal LV outflow geometry and or right ventricular interaction. Reduced aortic flow efficiency in TOF increases cardiac work and may be an important factor in long-term cardiac performance.

Authors+Show Affiliations

Division of Cardiology, Department of Pediatrics, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA.Department of Radiology, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA. Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA.Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA.Division of Cardiology, Department of Pediatrics, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA.Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA.Division of Cardiology, Department of Pediatrics, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA.Department of Radiology, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA.Department of Radiology, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA.Division of Cardiology, Department of Pediatrics, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA.Department of Surgery, Section of Congenital Heart Surgery, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31535124

Citation

Schäfer, Michal, et al. "Abnormal Aortic Flow Conduction Is Associated With Increased Viscous Energy Loss in Patients With Repaired Tetralogy of Fallot." European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, vol. 57, no. 3, 2020, pp. 588-595.
Schäfer M, Barker AJ, Jaggers J, et al. Abnormal aortic flow conduction is associated with increased viscous energy loss in patients with repaired tetralogy of Fallot. Eur J Cardiothorac Surg. 2020;57(3):588-595.
Schäfer, M., Barker, A. J., Jaggers, J., Morgan, G. J., Stone, M. L., Truong, U., Browne, L. P., Malone, L., Ivy, D. D., & Mitchell, M. B. (2020). Abnormal aortic flow conduction is associated with increased viscous energy loss in patients with repaired tetralogy of Fallot. European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, 57(3), 588-595. https://doi.org/10.1093/ejcts/ezz246
Schäfer M, et al. Abnormal Aortic Flow Conduction Is Associated With Increased Viscous Energy Loss in Patients With Repaired Tetralogy of Fallot. Eur J Cardiothorac Surg. 2020 03 1;57(3):588-595. PubMed PMID: 31535124.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Abnormal aortic flow conduction is associated with increased viscous energy loss in patients with repaired tetralogy of Fallot. AU - Schäfer,Michal, AU - Barker,Alex J, AU - Jaggers,James, AU - Morgan,Gareth J, AU - Stone,Matthew L, AU - Truong,Uyen, AU - Browne,Lorna P, AU - Malone,Ladonna, AU - Ivy,D Dunbar, AU - Mitchell,Max B, PY - 2019/06/13/received PY - 2019/07/29/revised PY - 2019/08/13/accepted PY - 2019/9/20/pubmed PY - 2019/9/20/medline PY - 2019/9/20/entrez KW - 4D-flow MRI KW - Aorta KW - Tetralogy of Fallot SP - 588 EP - 595 JF - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JO - Eur J Cardiothorac Surg VL - 57 IS - 3 N2 - OBJECTIVES: Aortopathy in tetralogy of Fallot (TOF) is characterized by increased aortic stiffness, dilation and reduced left ventricular (LV) function. Repair in infancy normalizes aortic dimensions in early childhood. Our prior work demonstrated that early TOF repair does not normalize aortic compliance and that abnormal ascending aortic flow patterns are prevalent. The objectives of this study were to: (i) determine whether proximal aortic flow-mediated viscous energy loss (EL') is elevated in patients with early TOF repair compared with healthy controls, and (ii) determine whether the degree of EL' is associated with LV function. METHODS: Forty-one patients post TOF repair with normalized aortic size and 15 healthy controls underwent 4-dimenisonal-flow magnetic resonance imaging flow analysis and EL' assessment. Correlations between EL', aortic size, and LV function were assessed. RESULTS: The TOF group had increased peak systolic thoracic aorta EL' (3.8 vs 1.5 mW, P = 0.004) and increased averaged EL' throughout the cardiac cycle (1.2 vs 0.5 mW, P = 0.003). Peak and mean systolic EL' in the ascending aorta was increased 2-fold in the TOF group compared with control (peak: 2.0 vs 0.9 mW, P = 0.007). Peak EL' measured along the entire thoracic aortic length correlated with LV ejection fraction (R = -0.45, P = 0.009), indexed LV end-systolic volume (R = -0.40, P = 0.010), and right ventricular end-systolic volume (R = -0.37, P = 0.034). CONCLUSIONS: Patients with repaired TOF exhibit abnormal aortic flow associated with increased EL' in the thoracic aorta. The magnitude of EL' is associated with LV function and volumes. Increased aortic EL' in TOF is likely due to inherently abnormal LV outflow geometry and or right ventricular interaction. Reduced aortic flow efficiency in TOF increases cardiac work and may be an important factor in long-term cardiac performance. SN - 1873-734X UR - https://www.unboundmedicine.com/medline/citation/31535124/Abnormal_aortic_flow_conduction_is_associated_with_increased_viscous_energy_loss_in_patients_with_repaired_tetralogy_of_Fallot_ L2 - https://academic.oup.com/ejcts/article-lookup/doi/10.1093/ejcts/ezz246 DB - PRIME DP - Unbound Medicine ER -