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Characterization of right ventricular diastolic performance after complete repair of tetralogy of Fallot. Restrictive physiology predicts slow postoperative recovery.
Circulation. 1995 Mar 15; 91(6):1782-9.Circ

Abstract

BACKGROUND

Prolonged postoperative recovery caused by a low cardiac output state occurs in some patients after complete repair of tetralogy of Fallot. Biventricular systolic function is usually well preserved in these patients. The contribution of impaired diastolic function, particularly of the right ventricle, has not been studied in detail; therefore, we performed a prospective study of right ventricular diastolic function in this patient group.

METHODS AND RESULTS

We studied biventricular systolic and diastolic function using Doppler echocardiographic examination. Tricuspid valve, superior vena caval, pulmonary arterial, and mitral valve Doppler spectrals were obtained during the first postoperative day in 35 patients aged 6 months to 45 years who underwent complete repair of tetralogy of Fallot. Biventricular systolic function was grossly normal in all patients. Isolated restrictive right ventricular physiology characterized by pulmonary arterial antegrade flow coincident with atrial systole and associated with prominent retrograde superior vena caval flow was seen in 17 of the 35 patients (group 1). This flow was augmented during the expiratory phase of positive pressure ventilation and abolished or greatly diminished during the inspiratory phase (P < .001). An increase in the duration of pulmonary regurgitation occurred during the inspiratory phase of positive pressure ventilation in these patients (P < .01). All patients with right ventricular restriction had a clinical picture compatible with a low cardiac output state, requiring prolonged stays in intensive care and the hospital. Clinical improvement was mirrored by resolution of the Doppler markers of right ventricular restriction in most of the patients.

CONCLUSIONS

Isolated right ventricular restriction is characterized by antegrade diastolic pulmonary arterial flow on Doppler echocardiography and is responsible for the slower postoperative course and clinical evidence of low cardiac output state in some patients after complete repair of tetralogy of Fallot.

Authors+Show Affiliations

Royal Brompton Hospital, London, UK.No affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

7882488

Citation

Cullen, S, et al. "Characterization of Right Ventricular Diastolic Performance After Complete Repair of Tetralogy of Fallot. Restrictive Physiology Predicts Slow Postoperative Recovery." Circulation, vol. 91, no. 6, 1995, pp. 1782-9.
Cullen S, Shore D, Redington A. Characterization of right ventricular diastolic performance after complete repair of tetralogy of Fallot. Restrictive physiology predicts slow postoperative recovery. Circulation. 1995;91(6):1782-9.
Cullen, S., Shore, D., & Redington, A. (1995). Characterization of right ventricular diastolic performance after complete repair of tetralogy of Fallot. Restrictive physiology predicts slow postoperative recovery. Circulation, 91(6), 1782-9.
Cullen S, Shore D, Redington A. Characterization of Right Ventricular Diastolic Performance After Complete Repair of Tetralogy of Fallot. Restrictive Physiology Predicts Slow Postoperative Recovery. Circulation. 1995 Mar 15;91(6):1782-9. PubMed PMID: 7882488.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characterization of right ventricular diastolic performance after complete repair of tetralogy of Fallot. Restrictive physiology predicts slow postoperative recovery. AU - Cullen,S, AU - Shore,D, AU - Redington,A, PY - 1995/3/15/pubmed PY - 1995/3/15/medline PY - 1995/3/15/entrez SP - 1782 EP - 9 JF - Circulation JO - Circulation VL - 91 IS - 6 N2 - BACKGROUND: Prolonged postoperative recovery caused by a low cardiac output state occurs in some patients after complete repair of tetralogy of Fallot. Biventricular systolic function is usually well preserved in these patients. The contribution of impaired diastolic function, particularly of the right ventricle, has not been studied in detail; therefore, we performed a prospective study of right ventricular diastolic function in this patient group. METHODS AND RESULTS: We studied biventricular systolic and diastolic function using Doppler echocardiographic examination. Tricuspid valve, superior vena caval, pulmonary arterial, and mitral valve Doppler spectrals were obtained during the first postoperative day in 35 patients aged 6 months to 45 years who underwent complete repair of tetralogy of Fallot. Biventricular systolic function was grossly normal in all patients. Isolated restrictive right ventricular physiology characterized by pulmonary arterial antegrade flow coincident with atrial systole and associated with prominent retrograde superior vena caval flow was seen in 17 of the 35 patients (group 1). This flow was augmented during the expiratory phase of positive pressure ventilation and abolished or greatly diminished during the inspiratory phase (P < .001). An increase in the duration of pulmonary regurgitation occurred during the inspiratory phase of positive pressure ventilation in these patients (P < .01). All patients with right ventricular restriction had a clinical picture compatible with a low cardiac output state, requiring prolonged stays in intensive care and the hospital. Clinical improvement was mirrored by resolution of the Doppler markers of right ventricular restriction in most of the patients. CONCLUSIONS: Isolated right ventricular restriction is characterized by antegrade diastolic pulmonary arterial flow on Doppler echocardiography and is responsible for the slower postoperative course and clinical evidence of low cardiac output state in some patients after complete repair of tetralogy of Fallot. SN - 0009-7322 UR - https://www.unboundmedicine.com/medline/citation/7882488/Characterization_of_right_ventricular_diastolic_performance_after_complete_repair_of_tetralogy_of_Fallot__Restrictive_physiology_predicts_slow_postoperative_recovery_ L2 - http://www.ahajournals.org/doi/full/10.1161/01.cir.91.6.1782?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -