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Time course of right ventricular functional parameters after surgical correction of tetralogy of Fallot determined by cardiac magnetic resonance

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Abstract

Aim

To evaluate changes of right ventricular (RV) parameters in follow-up examinations after corrected tetralogy of Fallot (TOF) by cardiac magnetic resonance (CMR).

Methods

CMR was performed twice within 4 years in 45 patients using a 1.5 T scanner. RV-volumes and pulmonary-regurgitant-fractions (PRF) were calculated from standard cine-sequences and flow-sensitive gradient-echo images, respectively. Patients were divided into two groups depending on the post-operative (po) interval (group 1 ≤5 years po; group 2 >5 years po) and subgroups depending on type of surgery (transannular vs. non-transannular). Patient groups were compared among each other and differences between 1st and 2nd CMR were assessed. Furthermore, patients were compared with 25 healthy volunteers.

Results

Compared with controls RV-size was increased (group 1: p = 0.007; group 2: p < 0.001) and RV function decreased (group 1: p = 0.02; group 2: p < 0.001) in po TOF-patients. PRF was higher in group 2 compared with group 1 (p = 0.04) and significant changes of PRF between 1st and 2nd CMR were found in group 2 (p < 0.01), but not in group 1 (p = 0.29). Compared with the non-transannular subgroup, PRF (p < 0.001) and RV end-diastolic-volume index (RV-EDVI) (p = 0.03) were significantly higher in patients with a transannular patch, EDVI increased between 1st and 2nd CMR. After correction, no significant changes of RV myocardial mass index (RV-MMI) were found.

Conclusion

After correction of TOF, RV-size, RV-muscle mass (RV-MM) was increased and ejection fraction decreased in “early” follow-up already. Whereas these parameters can remain stable over a long time period, the PRF significantly increased in “late” follow-up dependent on the po interval. Overall, transannular patching went along with higher PRF and bigger RV-size as well as a greater dynamic of these parameters in the time course, which makes this subgroup highly in need of regular follow-up examinations for the optimal timing of re-interventions. In contrast, the increased RV-MM demonstrated no regression po.

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References

  1. Norgaard MA, Lauridsen P, Helvind M, Pettersson G (1999) Twenty to thirty-seven-year follow-up after repair for tetralogy of Fallot. Eur J Cardiothorac Surg 16(2):125–130

    Article  PubMed  CAS  Google Scholar 

  2. Nollert G, Fischlein T, Bouterwek S, Bohmer C, Dewald O, Kreuzer E, Welz A, Netz H, Klinner W, Reichart B (1997) Long-term results of total repair of tetralogy of Fallot in adulthood: 35 years follow-up in 104 patients corrected at the age of 18 or older. Thorac Cardiovasc Surg 45(4):178–181

    Article  PubMed  CAS  Google Scholar 

  3. Kerst G, Kaulitz R, Sieverding L, Apitz C, Ziemer G, Hofbeck M (2010) Restrictive ventricular septal defect and critical subaortic stenosis in tetralogy of Fallot. Clin Res Cardiol 99(4):247–249

    Article  PubMed  Google Scholar 

  4. Gatzoulis MA, Balaji S, Webber SA, Siu SC, Hokanson JS, Poile C, Rosenthal M, Nakazawa M, Moller JH, Gilette PC, Redington AN (2000) Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multi-centre study. Lancet 356(9234):975–981

    Article  PubMed  CAS  Google Scholar 

  5. Louie EK, Bieniarz T, Moore AM, Levitsky S (1990) Reduced atrial contribution to left ventricular filling in patients with severe tricuspid regurgitation after tricuspid valvulectomy: a Doppler echocardiographic study. J Am Coll Cardiol 16(7):1617–1624

    Article  PubMed  CAS  Google Scholar 

  6. Lin SS, Reynertson SI, Louie EK, Levitsky S (1994) Right ventricular volume overload results in depression of left ventricular ejection fraction. Implications for the surgical management of tricuspid valve disease. Circulation 90(5 Pt 2):II209–II213

    PubMed  CAS  Google Scholar 

  7. Grothoff M, Spors B, Abdul-Khaliq H, Abd El Rahman MY, Aexi-Meskishvili V, Lange P, Felix R, Gutberlet M (2006) Pulmonary regurgitation is a powerful factor influencing QRS duration in patients after surgical repair of tetralogy of Fallot. A magnetic resonance imaging (MRI) study. Clin Res Cardiol 95(12):643–649

    Article  PubMed  CAS  Google Scholar 

  8. Davlouros PA, Kilner PJ, Hornung TS, Li W, Francis JM, Moon JC, Smith GC, Tat T, Pennell DJ, Gatzoulis MA (2002) Right ventricular function in adults with repaired tetralogy of Fallot assessed with cardiovascular magnetic resonance imaging: detrimental role of right ventricular outflow aneurysms or akinesia and adverse right-to-left ventricular interaction. J Am Coll Cardiol 40(11):2044–2052

    Article  PubMed  Google Scholar 

  9. Rebergen SA, Chin JG, Ottenkamp J, van der Wall EE, de Roos A (1993) Pulmonary regurgitation in the late post-operative follow-up of tetralogy of Fallot. Volumetric quantitation by nuclear magnetic resonance velocity mapping. Circulation 88(5 Pt 1):2257–2266

    PubMed  CAS  Google Scholar 

  10. Grothoff M, Spors B, Abdul-Khaliq H, Gutberlet M (2008) Evaluation of post-operative pulmonary regurgitation after surgical repair of tetralogy of Fallot: comparison between Doppler echocardiography and MR velocity mapping. Pediatr Radiol 38(2):186–191

    Article  PubMed  Google Scholar 

  11. Debl K, Djavidani B, Buchner S, Poschenrieder F, Schmid FX, Kobuch R, Feuerbach S, Riegger G, Luchner A (2009) Dilatation of the ascending aorta in bicuspid aortic valve disease: a magnetic resonance imaging study. Clin Res Cardiol 98(2):114–120

    Article  PubMed  CAS  Google Scholar 

  12. Eitel I, Fuernau G, Walther C, Razek V, Kivelitz D, Schuler G, Thiele H (2008) Delayed enhancement magnetic resonance imaging in isolated noncompaction of ventricular myocardium. Clin Res Cardiol 97(4):277–279

    Article  PubMed  Google Scholar 

  13. Schroeder J, Peterschroeder A, Vaske B, Butz T, Barth P, Oldenburg O, Bitter T, Burchert W, Horstkotte D, Langer C (2009) Cardiac volumetry in patients with heart failure and reduced ejection fraction: a comparative study correlating multi-slice computed tomography and magnetic resonance tomography. Reasons for intermodal disagreement. Clin Res Cardiol 98(11):739–747

    Article  PubMed  Google Scholar 

  14. Loukanov T, Sebening C, Springer W, Khalil M, Ulmer HE, Hagl M, Gorenflo M (2008) Replacement of valved right ventricular to pulmonary artery conduits: an observational study with focus on right ventricular geometry. Clin Res Cardiol 97(23):169–175

    Article  PubMed  Google Scholar 

  15. Gutberlet M, Boeckel T, Hosten N, Vogel M, Kuhne T, Oellinger H, Ehrenstein T, Venz S, Hetzer R, Bein G, Felix R (2000) Arterial switch procedure for D-transposition of the great arteries: quantitative evaluation of hemodynamic changes with cine MR imaging and phase-shift velocity mapping-initial experience. Radiology 214(2):467–475

    PubMed  CAS  Google Scholar 

  16. Vogel M, Gutberlet M, Dittrich S, Hosten N, Lange PE (1997) Comparison of transthoracic three-dimensional echocardiography with magnetic resonance imaging in the assessment of right ventricular volume and mass. Heart 78(2):127–130

    PubMed  CAS  Google Scholar 

  17. Beerbaum P, Barth P, Kropf S, Sarikouch S, Kelter-Kloepping A, Franke D, Gutberlet M, Kuehne T (2009) Cardiac function by MRI in congenital heart disease: impact of consensus training on interinstitutional variance. J Magn Reson Imaging 30(5):956–966

    Google Scholar 

  18. van Straten A, Vliegen HW, Lamb HJ, Roes SD, van der Wall EE, Hazekamp MG, de Roos A (2005) Time course of diastolic and systolic function improvement after pulmonary valve replacement in adult patients with tetralogy of Fallot. J Am Coll Cardiol 46(8):1559–1564

    Article  PubMed  Google Scholar 

  19. Knauth AL, Gauvreau K, Powell AJ, Landzberg MJ, Walsh EP, Lock JE, del Nido PJ, Geva T (2008) Ventricular size and function assessed by cardiac MRI predict major adverse clinical outcomes late after tetralogy of Fallot repair. Heart 94(2):211–216

    Article  PubMed  CAS  Google Scholar 

  20. Pattynama PM, Lamb HJ, van der Velde EA, van der Wall EE, de Roos A (1993) Left ventricular measurements with cine and spin-echo MR imaging: a study of reproducibility with variance component analysis. Radiology 187(1):261–268

    PubMed  CAS  Google Scholar 

  21. Pattynama PM, Lamb HJ, van der Velde EA, van der Geest RJ, van der Wall EE, de Roos A (1995) Reproducibility of MRI-derived measurements of right ventricular volumes and myocardial mass. Magn Reson Imaging 13(1):53–63

    Article  PubMed  CAS  Google Scholar 

  22. Gutberlet M, Abdul-Khaliq H, Grothoff M, Schröter J, Schmitt B, Röttgen R, Lange P, Vogel M, Felix R (2003) Vergleich der transthorakalen 3-D echokardiographie mit der mrt zur bestimmung linksventrikulärer volumina bei patienten mit pathologischer ventrikelgeometrie aufgrund angeborener herzfehler. Fortschr Röntgenstr 175(7):942–951

    Article  CAS  Google Scholar 

  23. Lotz J, Meier C, Leppert A, Galanski M (2002) Cardiovascular flow measurement with phase-contrast MR imaging: basic facts and implementation. Radiographics 22(3):651–671

    PubMed  Google Scholar 

  24. Gutberlet M, Abdul-Khaliq H, Stobbe H, Spors B, Fröhlich M, Knollmann F, Lange P, Hetzer R, Felix R (2001) Einsatz moderner schnittbildverfahren in der diagnostik von herzklappenerkrankungen. Zeitschrift für Kardiologie 90(6):2–12

    PubMed  Google Scholar 

  25. Helbing WA, Roest AA, Niezen RA, Vliegen HW, Hazekamp MG, Ottenkamp J, de Roos A, van der Wall EE (2002) ECG predictors of ventricular arrhythmias and biventricular size and wall mass in tetralogy of Fallot with pulmonary regurgitation. Heart 88(5):515–519

    Article  PubMed  CAS  Google Scholar 

  26. Abd El Rahman MY, Abdul-Khaliq H, Vogel M, Aexi-Meskishvili V, Gutberlet M, Lange PE (2000) Relation between right ventricular enlargement, QRS duration, and right ventricular function in patients with tetralogy of Fallot and pulmonary regurgitation after surgical repair. Heart 84(4):416–420

    Article  PubMed  CAS  Google Scholar 

  27. Davlouros PA, Karatza AA, Gatzoulis MA, Shore DF (2004) Timing and type of surgery for severe pulmonary regurgitation after repair of tetralogy of Fallot. Int J Cardiol 97(1):91–101

    Article  PubMed  Google Scholar 

  28. Bouzas B, Kilner PJ, Gatzoulis MA (2005) Pulmonary regurgitation: not a benign lesion. Eur Heart J 26(5):433–439

    Article  PubMed  Google Scholar 

  29. Frigiola A, Tsang V, Bull C, Coats L, Khambadkone S, Derrick G, Mist B, Walker F, van Doorn C, Bonhoeffer P, Taylor AM (2008) Biventricular response after pulmonary valve replacement for right ventricular outflow tract dysfunction: is age a predictor of outcome? Circulation 118(14Suppl):182–190

    Article  Google Scholar 

  30. Wald RM, Lyseggen E, Oechslin EN, Webb GD, Silversides CK (2009) Variability in surgical referral patterns for pulmonary valve replacement in adults with repaired tetralogy of Fallot. Congenit Heart Dis 4(4):231–238

    Article  PubMed  Google Scholar 

  31. Therrien J, Siu SC, McLaughlin PR, Liu PP, Williams WG, Webb GD (2000) Pulmonary valve replacement in adults late after repair of tetralogy of Fallot: are we operating too late? J Am Coll Cardiol 36(5):1670–1675

    Article  PubMed  CAS  Google Scholar 

  32. Vliegen HW, van Straten A, de Roos A, Roest AA, Schoof PH, Zwinderman AH, Ottenkamp J, van der Wall EE, Hazekamp MG (2002) Magnetic resonance imaging to assess the hemodynamic effects of pulmonary valve replacement in adults late after repair of tetralogy of Fallot. Circulation 106(13):1703–1707

    Article  PubMed  Google Scholar 

  33. van Straten A, Vliegen HW, Hazekamp MG, de Roos A (2005) Right ventricular function late after total repair of tetralogy of Fallot. Eur Radiol 15(4):702–707

    Article  PubMed  Google Scholar 

  34. Niezen RA, Helbing WA, van der Wall EE, van der Geest RJ, Rebergen SA, de Roos A (1996) Biventricular systolic function and mass studied with MR imaging in children with pulmonary regurgitation after repair for tetralogy of Fallot. Radiology 201(1):135–140

    PubMed  CAS  Google Scholar 

  35. Mitsuno M, Nakano S, Shimazaki Y, Taniguchi K, Kawamoto T, Kobayashi J, Matsuda H, Kawashima Y (1993) Fate of right ventricular hypertrophy in tetralogy of Fallot after corrective surgery. Am J Cardiol 72(9):694–698

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This work was supported in part by a grant of the Bundesministerium für Bildung und Forschung, competence network—congenital heart disease.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University of Leipzig – Heart Center, Strümpellstrasse 39, 04289, Leipzig, Germany

    M. Grothoff, J. Hoffmann, L. Lehmkuhl, S. Nitzsche, A. Mahler & M. Gutberlet

  2. Department of Congenital Heart Disease/Pediatric Cardiology, University Saarland, Kirrberger Strasse Gebäude 9, 66421, Homburg, Saarland, Germany

    H. Abdul-Khaliq

  3. Department of Congenital Heart Disease/Pediatric Cardiology, University of Leipzig – Heart Center, Strümpellstrasse 39, 04289, Leipzig, Germany

    I. Dähnert

  4. Department of Congenital Heart Disease/Pediatric Cardiology, Berlin Heart Center, Augustenburger Platz 1, 13353, Berlin, Germany

    F. Berger

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  1. M. Grothoff
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Correspondence to M. Grothoff.

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Grothoff, M., Hoffmann, J., Lehmkuhl, L. et al. Time course of right ventricular functional parameters after surgical correction of tetralogy of Fallot determined by cardiac magnetic resonance. Clin Res Cardiol 100, 343–350 (2011). https://doi.org/10.1007/s00392-010-0252-5

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  • DOI: https://doi.org/10.1007/s00392-010-0252-5

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