PMID- 24655705
OWN - NLM
STAT- MEDLINE
DCOM- 20140513
LR  - 20161125
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 167
IP  - 4
DP  - 2014 Apr
TI  - Ventricular geometric characteristics and functional benefit of mild right 
      ventricular outflow tract obstruction in patients with significant pulmonary 
      regurgitation after repair of tetralogy of Fallot.
PG  - 555-61
LID - S0002-8703(14)00023-4 [pii]
LID - 10.1016/j.ahj.2013.12.026 [doi]
AB  - BACKGROUND: Right ventricular (RV) outflow tract obstruction (RVOTO) might 
      protect the RV from adverse remodeling caused by significant pulmonary 
      regurgitation (PR) in patients with repaired tetralogy of Fallot (rTOF), but the 
      underlying mechanisms and influences on exercise tolerance remain unclear. This 
      study sought to investigate the impacts from mild RVOTO on ventricular remodeling 
      and exercise capacity in rTOF. METHODS: Eighty-five rTOF patients with a PR 
      fraction >/=20% were assessed with cardiac magnetic resonance, cardiopulmonary 
      exercise test, and echocardiography. Patients with a peak RVOT pressure gradient 
      20-50 mmHg were considered to have mild RVOTO (n = 29), while those with a 
      gradient <20 mmHg had isolated PR (n = 56). RESULTS: Comparing to patients with 
      isolated PR, patients with combined PR and mild RVOTO had smaller RV and RVOT 
      dimension, better RV and left ventricular (LV) ejection fraction (EF), and 
      superior exercise capacity. PR severity and RV mass/volume ratio were similar 
      between these 2 groups. LVEF coupled with RVEF only in patients with isolated PR. 
      In multivariate analysis, smaller RVOT dimension was independently related to 
      smaller RV dimension (P < .001) and higher RVEF (P = .005). Furthermore, mild 
      RVOTO was independently associated with higher peak oxygen consumption (P = .014) 
      and oxygen uptake efficiency slope (P = .005). CONCLUSIONS: Patients with 
      combined PR and mild RVOTO had better RV remodeling and exercise capacity 
      compared to those with isolated PR. Our findings confirm the benefits from mild 
      residual RVOTO support a policy of conservative RVOTO relief at repair.
CI  - Copyright (c) 2014 Mosby, Inc. All rights reserved.
FAU - Chen, Chun-An
AU  - Chen CA
AD  - Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
FAU - Chen, Ssu-Yuan
AU  - Chen SY
AD  - Department of Physical Medicine and Rehabilitation, National Taiwan University 
      Hospital, Taipei, Taiwan.
FAU - Wang, Jou-Kou
AU  - Wang JK
AD  - Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
FAU - Tseng, Wen-Yih Isaac
AU  - Tseng WY
AD  - Center for Optoelectronic Biomedicine, College of Medicine, National Taiwan 
      University, Taipei, Taiwan.
FAU - Chiu, Hsin-Hui
AU  - Chiu HH
AD  - Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; 
      Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan.
FAU - Chang, Chung-I
AU  - Chang CI
AD  - Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
FAU - Chiu, Ing-Sh
AU  - Chiu IS
AD  - Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
FAU - Chen, Yih-Sharng
AU  - Chen YS
AD  - Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
FAU - Yang, Ming-Chun
AU  - Yang MC
AD  - Department of Pediatrics, E-DA hospital and I-SHOU University, Kaohsiung, Taiwan.
FAU - Lu, Chun-Wei
AU  - Lu CW
AD  - Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
FAU - Lin, Ming-Tai
AU  - Lin MT
AD  - Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
FAU - Wu, Mei-Hwan
AU  - Wu MH
AD  - Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan. 
      Electronic address: wumh@ntu.edu.tw.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20140115
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
SB  - IM
MH  - Adult
MH  - Cardiac Surgical Procedures/*adverse effects
MH  - Echocardiography
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Ventricles/diagnostic imaging/*pathology/physiopathology
MH  - Humans
MH  - Magnetic Resonance Imaging, Cine/methods
MH  - Male
MH  - *Postoperative Complications
MH  - Prognosis
MH  - Pulmonary Valve Insufficiency/*diagnosis/etiology/physiopathology
MH  - Retrospective Studies
MH  - Severity of Illness Index
MH  - Tetralogy of Fallot/physiopathology/*surgery
MH  - Ventricular Function, Left/*physiology
MH  - Ventricular Outflow Obstruction/complications/*diagnosis/physiopathology
MH  - Ventricular Pressure
MH  - Ventricular Remodeling
EDAT- 2014/03/25 06:00
MHDA- 2014/05/14 06:00
CRDT- 2014/03/25 06:00
PHST- 2013/07/10 00:00 [received]
PHST- 2013/12/28 00:00 [accepted]
PHST- 2014/03/25 06:00 [entrez]
PHST- 2014/03/25 06:00 [pubmed]
PHST- 2014/05/14 06:00 [medline]
AID - S0002-8703(14)00023-4 [pii]
AID - 10.1016/j.ahj.2013.12.026 [doi]
PST - ppublish
SO  - Am Heart J. 2014 Apr;167(4):555-61. doi: 10.1016/j.ahj.2013.12.026. Epub 2014 Jan 
      15.