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Abnormal left ventricular flow organization following repair of tetralogy of Fallot.
J Thorac Cardiovasc Surg. 2020 Oct; 160(4):1008-1015.JT

Abstract

BACKGROUND

Left ventricular intracavitary flow (LVICF) characteristics reflect diastolic function. Right ventricular (RV) volume overload due to pulmonary regurgitation (PR) adversely impacts interventricular interactions and left ventricular (LV) function. This aimed to determine whether patients with PR and mild to moderate RV dilation after repair of tetralogy of Fallot (TOF) repair have abnormal LVICF, and to determine whether RV dilation and biventricular function correlate with LVICF abnormalities.

METHODS

Patients with repaired TOF with PR (n = 11) and controls (n = 11) underwent LVICF analysis. LV end-diastolic volume was partitioned into 4 flow components: direct flow, retained inflow, delayed ejection flow, and residual volume. Flow components were correlated with indexed biventricular size, function, and LV strain.

RESULTS

The TOF patients had reduced direct flow (35% vs 25%; P = .004) and increased residual volume (15% vs 24%; P = .026) compared with controls. Retained inflow and delayed ejection flow did not differ. Reduced direct flow correlated with increased RV end-diastolic volume index (R = 0.44; P = .042), RV end-systolic volume index (R = -0.46; P = .032), reduced RV ejection fraction (R = 0.45; P = .036), and reduced LV circumferential strain (R = 0.52; P = .014). Increased residual volume correlated with increased RV end-systolic volume index (R = 0.52; P = .013), reduced LV ejection fraction (R = -0.54; P = .010), and reduced LV circumferential strain (R = -0.44; P = .040).

CONCLUSIONS

Patients with repaired TOF with mild to moderate RV dilation have abnormal LV diastolic direct flow and increased recirculating residual volume. These changes correlate with the degree of RV dilation and impaired LV function.

Authors+Show Affiliations

Division of Cardiology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo. Electronic address: michal.schafer@ucdenver.edu.Department of Radiology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo.Section of Congenital Heart Surgery, School of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo.Department of Radiology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo; Department of Bioengineering, College of Engineering and Applied Sciences, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo.Division of Cardiology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo.Division of Cardiology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo.Section of Congenital Heart Surgery, School of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31924354

Citation

Schäfer, Michal, et al. "Abnormal Left Ventricular Flow Organization Following Repair of Tetralogy of Fallot." The Journal of Thoracic and Cardiovascular Surgery, vol. 160, no. 4, 2020, pp. 1008-1015.
Schäfer M, Browne LP, Jaggers J, et al. Abnormal left ventricular flow organization following repair of tetralogy of Fallot. J Thorac Cardiovasc Surg. 2020;160(4):1008-1015.
Schäfer, M., Browne, L. P., Jaggers, J., Barker, A. J., Morgan, G. J., Ivy, D. D., & Mitchell, M. B. (2020). Abnormal left ventricular flow organization following repair of tetralogy of Fallot. The Journal of Thoracic and Cardiovascular Surgery, 160(4), 1008-1015. https://doi.org/10.1016/j.jtcvs.2019.11.010
Schäfer M, et al. Abnormal Left Ventricular Flow Organization Following Repair of Tetralogy of Fallot. J Thorac Cardiovasc Surg. 2020;160(4):1008-1015. PubMed PMID: 31924354.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Abnormal left ventricular flow organization following repair of tetralogy of Fallot. AU - Schäfer,Michal, AU - Browne,Lorna P, AU - Jaggers,James, AU - Barker,Alex J, AU - Morgan,Gareth J, AU - Ivy,D Dunbar, AU - Mitchell,Max B, Y1 - 2019/11/22/ PY - 2019/06/25/received PY - 2019/10/13/revised PY - 2019/11/01/accepted PY - 2020/1/12/pubmed PY - 2020/11/18/medline PY - 2020/1/12/entrez KW - flow hemodynamics KW - left ventricle KW - tetralogy of Fallot SP - 1008 EP - 1015 JF - The Journal of thoracic and cardiovascular surgery JO - J Thorac Cardiovasc Surg VL - 160 IS - 4 N2 - BACKGROUND: Left ventricular intracavitary flow (LVICF) characteristics reflect diastolic function. Right ventricular (RV) volume overload due to pulmonary regurgitation (PR) adversely impacts interventricular interactions and left ventricular (LV) function. This aimed to determine whether patients with PR and mild to moderate RV dilation after repair of tetralogy of Fallot (TOF) repair have abnormal LVICF, and to determine whether RV dilation and biventricular function correlate with LVICF abnormalities. METHODS: Patients with repaired TOF with PR (n = 11) and controls (n = 11) underwent LVICF analysis. LV end-diastolic volume was partitioned into 4 flow components: direct flow, retained inflow, delayed ejection flow, and residual volume. Flow components were correlated with indexed biventricular size, function, and LV strain. RESULTS: The TOF patients had reduced direct flow (35% vs 25%; P = .004) and increased residual volume (15% vs 24%; P = .026) compared with controls. Retained inflow and delayed ejection flow did not differ. Reduced direct flow correlated with increased RV end-diastolic volume index (R = 0.44; P = .042), RV end-systolic volume index (R = -0.46; P = .032), reduced RV ejection fraction (R = 0.45; P = .036), and reduced LV circumferential strain (R = 0.52; P = .014). Increased residual volume correlated with increased RV end-systolic volume index (R = 0.52; P = .013), reduced LV ejection fraction (R = -0.54; P = .010), and reduced LV circumferential strain (R = -0.44; P = .040). CONCLUSIONS: Patients with repaired TOF with mild to moderate RV dilation have abnormal LV diastolic direct flow and increased recirculating residual volume. These changes correlate with the degree of RV dilation and impaired LV function. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/31924354/Abnormal_left_ventricular_flow_organization_following_repair_of_tetralogy_of_Fallot_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(19)33122-8 DB - PRIME DP - Unbound Medicine ER -