PMID- 30874802
OWN - NLM
STAT- MEDLINE
DCOM- 20201130
LR  - 20201130
IS  - 2047-2412 (Electronic)
IS  - 2047-2404 (Linking)
VI  - 20
IP  - 9
DP  - 2019 Sep 1
TI  - Severe right ventricular dilatation after repair of Tetralogy of Fallot is 
      associated with increased left ventricular preload and stroke volume.
PG  - 1020-1026
LID - 10.1093/ehjci/jez035 [doi]
AB  - AIMS: Pulmonary regurgitation (PR) and right ventricular (RV) dilatation are 
      common in repaired tetralogy of Fallot (rTOF). Left ventricular (LV) dysfunction 
      is an important risk factor in rTOF. The effect of PR/RV dilatation on LV 
      performance and RV-LV interactions in rTOF are incompletely understood. We 
      examined LV responses and exercise capacity in rTOF, both before and after 
      pulmonary valve replacement (PVR). METHODS AND RESULTS: Cardiac magnetic 
      resonance imaging scans in 126 rTOF patients (age 17.3 +/- 7.6 years) were 
      analysed, comparing subjects with indexed RV end-diastolic volume (RVEDVi) 
      <170 mL/m2 (mild/moderate dilatation, n = 95) and RVEDVi >/=170 mL/m2 (severe 
      dilatation, n = 31). Indexed PR volume (PRVi), RV end-systolic (RVESVi), RV 
      end-diastolic (RVEDVi), RV stroke volume (RVSVi), net pulmonary forward flow 
      (NPFFi), LV end-diastolic (LVEDVi), LV end-systolic (LVESVi), LV stroke volume 
      (LVSVi), RV and LV ejection fraction (EF), and diastolic septal curvature were 
      obtained. Peak aerobic capacity (VO2 max) was measured. In a subset (n = 30), 
      measures were obtained pre-and-post surgical PVR. Compared to those with 
      mild/moderate RV dilatation, patients with severe RV dilation had greater PRVi 
      (38 +/- 12 vs. 24 +/- 9 mL/m2, P < 0.0001), NPFFi (53 +/- 9 vs. 44 +/- 11 mL/m2, 
      P < 0.0001), LVEDVi (87 +/- 14 vs. 73 +/- 13 mL/m2, P < 0.0001), LVESVi (39 +/- 12 vs. 
      30 +/- 8 mL/m2, P < 0.0001), and LVSVi (48 +/- 7 vs. 43  +/-  8 mL/m2, P = 0.002) but 
      lower RV ejection fraction (46 +/- 8 vs. 53 +/- 7%, P < 0.0001). Septal curvature and 
      VO2 max were similar in both groups. After PVR, there was no change in LVEDVi, 
      LVSVi, septal curvature, or VO2 max. CONCLUSIONS: Chronic PR with severe RV 
      dilatation is associated with increased NPFFi, LVEDVi, and LVSVi. This may 
      potentially explain preserved exercise capacity in rTOF with severe PR and RV 
      dilatation.
CI  - Published on behalf of the European Society of Cardiology. All rights reserved. (c) 
      The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.
FAU - Gnanappa, Ganesh Kumar
AU  - Gnanappa GK
AD  - The Heart Centre for Children, The Children's Hospital at Westmead, Corner of 
      Hawkesbury Road and Hainsworth Street, Westmead, New South Wales 2145, Australia.
FAU - Celermajer, David S
AU  - Celermajer DS
AD  - Department of Cardiology, The Royal Prince Alfred Hospital, Missenden Road, 
      Camperdown, New South Wales 2050, Australia.
AD  - Sydney Medical School, The University of Sydney, Sydney, Australia.
FAU - Zhu, Danyi
AU  - Zhu D
AD  - School of Electrical and Information Technology, University of Sydney, Maze 
      Crescent, Darlington, New South Wales 2006, Australia.
FAU - Puranik, Rajesh
AU  - Puranik R
AD  - The Heart Centre for Children, The Children's Hospital at Westmead, Corner of 
      Hawkesbury Road and Hainsworth Street, Westmead, New South Wales 2145, Australia.
AD  - Department of Cardiology, The Royal Prince Alfred Hospital, Missenden Road, 
      Camperdown, New South Wales 2050, Australia.
AD  - Sydney Medical School, The University of Sydney, Sydney, Australia.
FAU - Ayer, Julian
AU  - Ayer J
AD  - The Heart Centre for Children, The Children's Hospital at Westmead, Corner of 
      Hawkesbury Road and Hainsworth Street, Westmead, New South Wales 2145, Australia.
AD  - Sydney Medical School, The University of Sydney, Sydney, Australia.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Eur Heart J Cardiovasc Imaging
JT  - European heart journal. Cardiovascular Imaging
JID - 101573788
SB  - IM
MH  - Adolescent
MH  - Exercise Tolerance
MH  - Female
MH  - Humans
MH  - *Magnetic Resonance Imaging, Cine
MH  - Male
MH  - Postoperative Complications/*diagnostic imaging/*physiopathology
MH  - Pulmonary Valve Insufficiency/diagnostic imaging/physiopathology
MH  - Stroke Volume
MH  - Tetralogy of Fallot/*surgery
MH  - Ventricular Dysfunction, Right/*diagnostic imaging/*physiopathology
OTO - NOTNLM
OT  - cardiovascular magnetic resonance
OT  - exercise capacity
OT  - left ventricle
OT  - pulmonary valve replacement
OT  - repaired Tetralogy of Fallot
EDAT- 2019/03/16 06:00
MHDA- 2020/12/01 06:00
CRDT- 2019/03/16 06:00
PHST- 2018/08/21 00:00 [received]
PHST- 2018/12/11 00:00 [revised]
PHST- 2019/02/18 00:00 [accepted]
PHST- 2019/03/16 06:00 [pubmed]
PHST- 2020/12/01 06:00 [medline]
PHST- 2019/03/16 06:00 [entrez]
AID - 5381106 [pii]
AID - 10.1093/ehjci/jez035 [doi]
PST - ppublish
SO  - Eur Heart J Cardiovasc Imaging. 2019 Sep 1;20(9):1020-1026. doi: 
      10.1093/ehjci/jez035.