Influence of Pulmonary Valve Function Preservation Technique for Tetralogy of Fallot Repair on Right Ventricular Performance in Children
DOI:
https://doi.org/10.1532/hsf.2923Keywords:
Fallot Tetralogy repair, RV dysfunction, myocardial performance indexAbstract
Background: Right ventricular (RV) ejection fraction may remain normal or even high despite significant impairment of RV myocardial performance in cases of total repair for tetralogy of Fallot (TOF). The aim of this study is to evaluate the influence of pulmonary valve function preservation (PVFP) versus monocuspid transannular patch augmentation (MTAPA) surgical strategies for Fallot repair on postoperative RV performance.
Methods: This retrospective study enrolled all patients
(N = 480) who had TOF repaired at our center over a period of 7 years (March 2012 to January 2019). Group I included 377 patients (78.5%) who underwent TOF repair with MTAPA, and group II included 103 patients (21.5%) who underwent TOF repair with PVFP, which included all patients with pulmonary valve sparing with limited sub- or supravalvular patch. Patients’ preoperative and postoperative echocardiography and other parameters (ventilation time, intensive care unit [ICU] stay duration, and RV myocardial performance index [RVMPI]) were recorded to evaluate RV function.
Results: We observed a significant statistical difference in the postoperative course between groups I and II, with excellent midterm outcomes for group II. A remarkable significant improvement of RVMPI took place in group II versus group I (P < .0001), as well as a significant decline in pulmonary regurgitation progression (P < .0001). The immediate postoperative RVMPI in group I (0.79 ± 0.63) versus that in group II (0.36 ± 0.17) was significantly higher (P < .0001), as was the late postoperative RVMPI (group I, 0.64 ± 0.25; group II, 0.49 ± 0.17; P < 0001). The postoperative RV outflow tract was decreased in group II versus group I. Group II had a significantly shorter duration on mechanical ventilation and in the ICU and less need for inotropes.
Conclusion: We conclude that TOF repair patients have excellent RV myocardial performance with the PVFP surgical strategy in comparison with MTAPA.
References
Awori MN, Leong W, Artrip JH, O’Donnell C. 2013. Tetralogy of Fallot repair: Optimal z-score use for transannular patch insertion. Eur J Cardio-Thorac Surg 43:483-486.
Bacha EA, Scheule AM, Zurakowski D, et al. 2001. Long-term results after early primary repair of tetralogy of Fallot. J Thorac Cardiovasc Surg 122:154-161.
Bonnemains L, Stos B, Vaugrenard T, Marie PY, Odille F, Boudjemline Y. 2012. Echocardiographic right ventricle longitudinal contraction indices cannot predict ejection fraction in post-operative Fallot children. Eur Heart J Cardiovasc Imaging 13:235-242.
Carminati M, Pluchinotta FR, Piazza L, et al. 2015. Echocardiographic assessment after surgical repair of tetralogy of fallot. Front Pediatr 3:3.
Eidem BW, O’Leary PW, Tei C, Seward JB. 2000. Usefulness of the myocardial performance index for assessing right ventricular function in congenital heart disease. Am J Cardiol 86:654-658
Frigiola A, Redington AN, Cullen S, Vogel M. 2004. Pulmonary regurgitation is an important determinant of right ventricular contractile dysfunction in patients with surgically repaired tetralogy of Fallot. Circulation 110(suppl 2):153-157.
Gatzoulis MA, Balaji S, Webber SA, et al. 2000. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: A multicentre study. Lancet 356:975-981.
Geva T, Sandweiss BM, Gauvreau K, Lock JE, Powell AJ. 2004. Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging. J Am Coll Cardiol 43:1068-1074.
Grignola JC, Ginés F and Guzzo D. 2006. Comparison of the Tei index with invasive measurements of right ventricular function. Int J Cardiol 113:25-33.
Helbing WA, Niezen RA, Le Cessie S, et al. 1996. Right ventricular diastolic function in children with pulmonary regurgitation after repair of tetralogy of Fallot: Volumetric evaluation by magnetic resonance velocity mapping. J Am Coll Cardiol 28:1827-1835.
Karl TR, Sano S, Pornviliwan S, Mee RBB. 1992. Tetralogy of Fallot: Favorable outcome of nonneonatal transatrial, transpulmonary repair. Ann Thorac Surg 54:903-907.
Kirklin JW, Blackstone EH, Jonas RA, et al. 1992. Morphologic and surgical determinants of outcome events after repair of tetralogy of Fallot and pulmonary stenosis: A two-institutional study. J Thorac Cardiovasc Surg 103:706-723.
Koestenberger M, Nagel B, Avian A, et al. 2012. Systolic right ventricular function in children and young adults with pulmonary artery hypertension secondary to congenital heart disease and tetralogy of Fallot: Tricuspid annular plane systolic excursion (TAPSE) and magnetic resonance imaging data. Congenit Heart Dis 7:250-258.
Lee N, Taylor MD, Banerjee RK. 2015. Right ventricle-pulmonary circulation dysfunction: A review of energy-based approach. Biomed Eng Online 14(suppl 1):S8.
Lozano-Balseiro M, Garcia-Vieites M, Martínez-Bendayán I, et al. 2019. Valve-sparing tetralogy of Fallot repair with intraoperative dilation of the pulmonary valve. Mid-term results. Semin Thorac Cardiovasc Surg 31:828-834.
Mahran Y, Schueler R, Weber M, et al. 2016. Noninvasive model including right ventricular speckle tracking for the evaluation of pulmonary hypertension. World J Cardiol 8:472-480.
Puchalski MD, Williams RV, Askovich B, Minich LL, Mart C, Tani LY. 2007. Assessment of right ventricular size and function: Echo versus magnetic resonance imaging. Congenit Heart Dis 2:27-31.
Rebergen SA, Chin JGJ, Ottenkamp J, Van der Wall EE, de Roos A. 1993. Pulmonary regurgitation in the late postoperative follow-up of tetralogy of Fallot: Volumetric quantification by MR velocity mapping. Circulation 88(pt 1):2257-2266.
Roberson DA, Cui W. 2007. Right ventricular Tei index in children: Effect of method, age, body surface area, and heart rate. J Am Soc Echocardiogr 20:764-770.
Rudski LG, Lai WW, Afilalo J, et al. 2010. Guidelines for the echocardiographic assessment of the right heart in adult: A report from the American Society of Echocardiography. J Am Soc Echocardiogr 23:700-701.
Schwerzmann M, Samman AM, Salehian O, et al. 2007. Comparison of echocardiographic and cardiac magnetic resonance imaging for assessing right ventricular function in adults with repaired tetralogy of Fallot. Am J Cardiol 99:1593-1597.
Selly JB, Iriart X, Roubertie F, et al. 2015. 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 108:5-15.
Singh GK, Greenberg SB, Yap YS, Delany DP, Keeton BR, Monro JL. 1998. Right ventricular function and exercise performance late after primary repair of tetralogy of Fallot with the transannular patch in infancy. Am J Cardiol 81:1378-1382.
Song B, Qi Q, Liu R, Xing W, Tang H, Li Y. 2015. Clinical value of Tei index in pediatric patients with repaired tetralogy of Fallot. Int J Clin Exp Med 8:7971-7976.
Su HM, Lin TH, Voon WC, Lee KT, Chu CS, Yen HW, Lai WT, Sheu SH. 2007. Correlation of Tei index obtained from tissue Doppler echocardiography with invasive measurements of left ventricular performance. Echocardiography 24:252-257.
Suzuki J-I, Chang J-M, Caputo GR, Higgins CB. 1991. Evaluation of right ventricular early diastolic filling by cine nuclear magnetic resonance imaging in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 18:120-126.
Tei C, Dujardin KS, Hodge DO, et al. 1996. Doppler echocardiographic index for assessment of global right ventricular function. J Am Soc Echocardiogr 9:838-847.
Tei C, Dujardin KS, Hodge DO, Kyle RA, Tajik JA, Seward JB. 1996. Doppler index combining systolic and diastolic myocardial performance: Clinical value in cardiac amyloidisis. J Am Coll Cardiol 28:658-664.
Weidemann F, Eyskens B, Mertens L, et al. 2002. Quantification of regional right and left ventricular function by ultrasonic strain rate and strain indexes after surgical repair of tetralogy of Fallot. Am J Cardiol 90:133-138.
Yoo BW, Kim JO, Kim YJ, Choi JY, Park HK, Park YH, Sul JH. 2012. Impact of pressure load caused by right venricular outflow tract obstruction on right ventricular volume overload in patients with repaired tetralogy of Fallot. J Thorac Cardiovasc Surg 143:1299-1304.
