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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

Periklis A. Davlouros, MD^*, Philip J. Kilner, MD, PhD, Tim S. Hornung, MD^*, Wei Li, MD, PhD^*, Jane M. Francis, DCR(R), James C. C. Moon, MD, Gillian C. Smith, BSe, Tri Tat, PhD, Dudley J. Pennell, MD, FACC and Michael A. Gatzoulis, MD, PhD, FACC^*,*

^* Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
Cardiac Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom
Medical Statistics, Royal Brompton Hospital, London, United Kingdom

View larger version (147K): [in a new window]   Figure 1 The right ventricular outflow tract (RVOT) after repair of tetralogy of Fallot assessed with cardiovascular magnetic resonance. Short axis-cardiovascular magnetic resonance TrueFISP images, end-systole, and end-diastole, at the RVOT level. (A, B) Lack of systolic thickening and inward motion of the RVOT in a tetralogy patient with transannular patch repair and RVOT akinesia (open arrows). The pulmonary valve is not visible. Black arrowhead = pulmonary regurgitant jet. (C, D) Systolic thickening and inward movement of the RVOT in a patient without patch repair (white arrows). Gray arrow = intact and competent pulmonary valve. LV = left ventricle; RV = right ventricle.

View larger version (31K): [in a new window]   Figure 2 Relation of type of right ventricular outflow tract (RVOT) reconstruction and late RVOT aneurysm/akinesia to right ventricular volume, function, and pulmonary regurgitant fraction (PRF). (A) There was a significant difference in the mean right ventricular end-diastolic volume index (RVEDVi), right ventricular end-systolic volume index (RVESVi), and PRF in the three RVOT reconstruction subgroups. The two patch subgroups did not differ from each other. PRF was significantly higher in patients with transannular patch compared to those without any patch (p = 0.003). (B) The combined subgroup of RVOT and transannular patch had significantly higher RVEDVi, RVESVi, and PRF compared to the nonpatched group. (C) There was a significant difference in RVEDVi, RVESVi, and right ventricular ejection fraction (RVEF) between patients with and without RVOT aneurysm/akinesia. Bars represent 95% confidence intervals (CI). ANOVA = analysis of variance.

View larger version (56K): [in a new window]   Figure 3 Type of right ventricular outflow tract (RVOT) reconstruction and late RVOT aneurysm/akinesia. (A) No statistically significant difference was seen in the incidence of either RVOT aneurysm or akinesia among patients who underwent RVOT reconstruction with transannular patch, RVOT patch, or without usage of a patch. The cumulative incidence of RVOT aneurysm and akinesia in patients repaired without patch was marginally lower compared to those repaired with transannular patch (2p = 0.07). (B) The cumulative incidence of RVOT aneurysm and akinesia in patients repaired without patch was lower but not significantly different compared to patients with RVOT transannular patching.

View larger version (15K): [in a new window]   Figure 4 Ventricular-ventricular interaction late after repair of tetralogy of Fallot. Positive correlation between left ventricular ejection fraction (LVEF) and right ventricular ejection fraction (RVEF) assessed by cardiovascular magnetic resonance.