ASSESSMENT OF ANATOMICAL PARTS OF THE RIGHT VENTRICLE IN PATIENTS AFTER TETRALOGY OF FALLOT REPAIR

Objectives. The objective of the study was to investigate the influence of the main right ventricular (RV) anatomical components on global RV function by using CMRI after tetralogy of Fallot (TOF) repair based on various surgical approaches.

Materials and Methods. A total of 52 asymptomatic, clinically stable patients (28 boys and 24 girls) aged 7.5 (5.5; 9.5) years were retrospectively examined after TOF repair to assess RV dysfunction in the Pediatric Cardiac Surgery Department of the Novosibirsk Research Institute of Circulation Pathology n.a. acad. E.N. Meshalkin. All patients were divided into 2 groups depending on surgery technique of TOF repair: transannular plasty (group 1, 26 pts) or TOF repair with pulmonary annulus preservation (group 2, 26 pts).

Results. Right ventricular ejection fraction for the entire ventricle and for its parts was significantly higher in group 2 whereas RV end diastolic volume (EDV) for the entire ventricle and for its parts and stroke volume (SV) were significantly higher in group 1. Pulmonary regurgitation was also higher in group 1: 36.7 (32; 44) versus 13.2 (3; 14) (p>0.01). Odds ratio for pulmonary regurgitation was lower in group 2 in comparison with group 1: OR (95% confidence interval, CI) 0.19 (0.04–0.72), р=0.02.

Conclusions. Right ventricular function after TOF repair depends on the type of right ventricular outflow tract (RVOT) reconstruction. Through separate functional analysis of the anatomical RV components, this study demonstrated that the global RV function is decreased in patients after transannular plasty. Long term RV dysfunction in group with transannular plasty was associated with significant pulmonary regurgitation and the presence of large akinetic RVOT region involving the sinus part in the contraction.

1. Kadam S.V., Tailor K.B., Kulkarni S. et al. Effect of dexmeditomidine on postoperative junctional ectopic tachycardia after complete surgical repair of tetralogy of Fallot: A prospective randomized controlled study // Ann. Card. Anaesth. – 2015. – Vol. 18(3). – P. 323–328.

2. Baumgartner H., Bonhoeffer P., De Groot N.M. et al. ESC guidelines for the management of grown up congenital heart disease (new version 2010) // Eur. Heart J. – 2010. – Vol. 31(23). – P. 2915–2957.

3. Marterer R., Hongchun Z., Tschauner S. et al. Cardiac MRI assessment of right ventricular function: impact of right bundle branch block on the evaluation of cardiac performance parameters // Eur. Radiol. – 2015. – Vol. 25 (12). – P. 3528–3535.

4. Суханов С.Г., Орехова Е.Н., Синельников Ю.С. и др. Механическая функция правого желудочка у детей первого года жизни с тетрадой Фалло // Патология кровообращения и кардиохирургия. – 2015. – Т. 19, № 3. – С. 19–25.

5. Gorter T.M., van Melle J.P., Freling H.G. et al. Pulmonary regurgitant volume is superior to fraction using background-corrected phase contrast MRI in determining the severity of regurgitation in repaired tetralogy of Fallot // Int. J. Cardiovasc. Imaging. – 2015. – Vol. 31(6). – P. 1169–1177.

6. Bove T., Vandekerckhove K., Devos D. et al. Functional analysis of the anatomical right ventricular components: should assessment of right ventricular function after repair of tetralogy of Fallot be refined? // Eur. J. Cardiothorac. Surg. – 2014. – Vol. 45. – P. e6 e12.

7. Freling H.G., Pieper P.G., Vermeulen K.M. et al. Improved cardiac MRI volume measurements in patients with tetralogy of Fallot by independent end systolic and end diastolic phase selection // PLoS One. – 2013. – Vol. 8(1). – P. e55462.

8. Lytrivi I.D., Ko H.H., Srivastava S. et al. Regional differences in right ventricular systolic function as determined by cine magnetic resonance imaging after infundibulotomy // Am. J. Cardiol. – 2004. – Vol. 94. – P. 970–973.

9. Koestenberger M., Ravekes W., Nagel B. et al. Longitudinal systolic ventricular interaction in pediatric and young adult patients with TOF: a cardiac magnetic resonance and M mode echocardiographic study // Int. J. Cardiovasc. Imaging. – 2013. – Vol. 29. – P. 1707–1715.

10. Alghamdi M.H., Mertens L., Lee W. et al. Longitudinal right ventricular function is a better predictor of right ventricular contribution to exercise performance than global or outflow tract ejection fraction in tetralogy of Fallot: a combined echocardiography and magnetic resonance study // Eur. Heart J. Cardiovasc. Imaging. – 2013. – Vol. 14. – P. 235–239.

11. Wald R.M., Haber I., Wald R. et al. Effects of regional dysfunction and late gadolinium enhancement on global right ventricular function and exercise capacity in patients with repaired tetralogy of Fallot // Circulation. – 2009. – Vol. 119. – P. 1370–1377.

12. Morcos P., Vick G.W., Sahn D.J. et al. Correlation of right ventricular ejection fraction and tricuspid annular plane systolic excursion in tetralogy of Fallot by magnetic resonance imaging // Int. J. Cardiovasc. Imaging. – 2009. – Vol. 25. – P. 263–270.

13. Selly J.B., Iriart X., Roubertie F. et al. Multivariable assessment of the right ventricle by echocardiography in patients with repaired tetralogy of Fallot undergoing pulmonary valve replacement: a comparative study with magnetic resonance imaging // Arch. Cardiovasc. Dis. – 2015. – Vol. 108(1). – P. 5–15.

14. Sabate Rotes A., Connolly H.M., Warnes C.A. et al. Ventricular arrhythmia risk stratification in patients with tetralogy of Fallot at the time of pulmonary valve replacement // Circ. Arrhythm. Electrophysiol. – 2015. – Vol. 8(1). – P. 110–116.

15. Bigdelian H., Mardani D., Sedighi M. The effect of pulmonary valve replacement surgery on hemodynamics of patients who underwent repair of tetralogy of Fallot // J. Cardiovasc. Thorac. Res. – 2015. – Vol. 7(3). – P. 122–125.

16. Oosterhof T., van Straten A., Vliegen H.W. et al. Preoperative thresholds for pulmonary valve replacement in patients with corrected tetralogy of Fallot using cardiac magnetic resonance // Circulation. – 2007. – Vol. 116. – P. 545–551.

17. Buechel E.R., Dave H.H., Kellenberger C.J. et al. Remodelling of the right ventricle after early pulmonary valve replacement in children with repaired tetralogy of Fallot: assessment by cardiovascular magnetic resonance // Eur. Heart J. – 2005. – Vol. 26. – P. 2721–2727.

18. Therrien J., Siu S.C., McLaughlin P.R. et al. Pulmonary valve replacement in adults late after repair of tetralogy of Fallot: are we operating too late? // J. Am. Coll. Cardiol. – 2000. – Vol. 36. – P. 1670–1675.