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Avesani M, Sabatino J, Borrelli N, Cattapan I, Leo I, Pelaia G, Moscatelli S, Bianco F, Bassareo P, Martino F, Leonardi B, Oreto L, Guccione P, Di Salvo G. The mechanics of congenital heart disease: from a morphological trait to the functional echocardiographic evaluation. Front Cardiovasc Med 2024; 11:1301116. [PMID: 38650919 PMCID: PMC11033364 DOI: 10.3389/fcvm.2024.1301116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 03/28/2024] [Indexed: 04/25/2024] Open
Abstract
Advances in pediatric cardiac surgery have resulted in a recent growing epidemic of children and young adults with congenital heart diseases (CHDs). In these patients, congenital defects themselves, surgical operations and remaining lesions may alter cardiac anatomy and impact the mechanical performance of both ventricles. Cardiac function significantly influences outcomes in CHDs, necessitating regular patient follow-up to detect clinical changes and relevant risk factors. Echocardiography remains the primary imaging method for CHDs, but clinicians must understand patients' unique anatomies as different CHDs exhibit distinct anatomical characteristics affecting cardiac mechanics. Additionally, the use of myocardial deformation imaging and 3D echocardiography has gained popularity for enhanced assessment of cardiac function and anatomy. This paper discusses the role of echocardiography in evaluating cardiac mechanics in most significant CHDs, particularly its ability to accommodate and interpret the inherent anatomical substrate in these conditions.
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Affiliation(s)
- Martina Avesani
- Division of Paediatric Cardiology, Department of Women’s and Children’s Health, University Hospital of Padua, Padua, Italy
| | - Jolanda Sabatino
- Paediatric Cardiology and Congenital Heart Disease Unit, Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Nunzia Borrelli
- Adult Congenital Heart Disease Unit, A.O. dei Colli, Monaldi Hospital, Naples, Italy
| | - Irene Cattapan
- Division of Paediatric Cardiology, Department of Women’s and Children’s Health, University Hospital of Padua, Padua, Italy
| | - Isabella Leo
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Giulia Pelaia
- Paediatric Unit, Department of Science of Health, Magna Graecia University, Catanzaro, Italy
| | - Sara Moscatelli
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Francesco Bianco
- Department of Pediatrics and Congenital Cardiac Surgery and Cardiology, Ospedali Riuniti, Ancona, Italy
| | - PierPaolo Bassareo
- Department of Cardiology, Mater Misericordiae University Hospital and Our Lady’s Children’s Hospital, University College of Dublin, Crumlin, Ireland
| | - Francesco Martino
- Department of Internal Clinical, Anesthesiological and Cardiovascular Sciences, La Sapienza University, Rome, Italy
| | - Benedetta Leonardi
- Department of Pediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, Bambino Gesu Children’s Hospital and Research Institute, IRCCS, Rome, Italy
| | - Lilia Oreto
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- Mediterranean Pediatric Cardiology Center, Bambino Gesù Children’s Hospital, Taormina, Italy
| | - Paolo Guccione
- Department of Pediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, Bambino Gesu Children’s Hospital and Research Institute, IRCCS, Rome, Italy
| | - Giovanni Di Salvo
- Division of Paediatric Cardiology, Department of Women’s and Children’s Health, University Hospital of Padua, Padua, Italy
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Baroutidou A, Ntiloudi D, Kasinos N, Nyktari E, Giannakoulas G. Multi-modality imaging of the systemic right ventricle in congenital heart disease. Echocardiography 2024; 41:e15749. [PMID: 38284684 DOI: 10.1111/echo.15749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/26/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024] Open
Abstract
A comprehensive and structured imaging approach in the evaluation of the systemic right ventricle (sRV) in patients with complete transposition of the great arteries (TGA) after atrial switch procedure and congenitally corrected transposition of the great arteries (ccTGA) is a key for their optimal lifelong surveillance. Despite the improvements in cardiovascular imaging of adults with congenital heart disease (ACHD), the imaging of sRV remains an ongoing challenge due to its complex morphology and the difficulty in applying the existing knowledge for the systemic left ventricle. While cardiac magnetic resonance (CMR) is considered the gold standard imaging method, echocardiographic evaluation is primarily preferred in everyday clinical setting. Although qualitative assessment of its systolic function is primarily used, the introduction of advanced echocardiographic techniques, such as speckle tracking echocardiography (STE) and three-dimensional echocardiography (3DE), has provided new insights into the optimal assessment of the sRV. Standardized quantitative parameters remain to be elucidated, and morphometric and mechanistic studies are warranted to validate reference ranges for the sRV. This review highlights the challenges in the optimal evaluation of sRV and summarizes the available imaging tools. HIGHLIGHTS: CMR is the gold standard imaging method of sRV. Qualitative assessment of the systolic function of sRV is primarily used. Advanced echocardiographic techniques (STE and 3DE) provide optimal sRV assessment. Reference ranges for the sRV indices are warranted to be validated.
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Affiliation(s)
- Amalia Baroutidou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Despoina Ntiloudi
- Department of Cardiology, Tzaneio General Hospital of Piraeus, Piraeus, Greece
| | - Nearchos Kasinos
- Department of Cardiology, Tzaneio General Hospital of Piraeus, Piraeus, Greece
- Echocardiography Laboratory, Tzaneio General Hospital of Piraeus, Piraeus, Greece
| | - Evangelia Nyktari
- Cardiovascular MRI Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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3
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The pivotal role of tricuspid regurgitation in the failing systemic right ventricle: The “chicken and egg story‿. Arch Cardiovasc Dis 2022; 115:476-486. [DOI: 10.1016/j.acvd.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/02/2022] [Accepted: 05/09/2022] [Indexed: 11/18/2022]
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Zandstra TE, Jongbloed MRM, Widya RL, ten Harkel ADJ, Holman ER, Mertens BJA, Vliegen HW, Egorova AD, Schalij MJ, Kiès P. Validation and Feasibility of Echocardiographic Assessment of Systemic Right Ventricular Function: Serial Correlation With MRI. Front Cardiovasc Med 2021; 8:644193. [PMID: 33796574 PMCID: PMC8008818 DOI: 10.3389/fcvm.2021.644193] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 02/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Inherent to its geometry, echocardiographic imaging of the systemic right ventricle (RV) is challenging. Therefore, echocardiographic assessment of systemic RV function may not always be feasible and/or reproducible in daily practice. Here, we aim to validate the usefulness of a comprehensive range of 32 echocardiographic measurements of systemic RV function in a longitudinal cohort by serial assessment of their correlations with cardiac magnetic resonance (CMR)-derived systemic RV ejection fraction (RVEF). Methods: A single-center, retrospective cohort study was performed. Adult patients with a systemic RV who underwent a combination of both CMR and echocardiography at two different points in time were included. Off-line analysis of echocardiographic images was blinded to off-line CMR analysis and vice versa. In half of the echocardiograms, measurements were repeated by a second observer blinded to the results of the first. Correlations between echocardiographic and CMR measures were assessed with Pearson's correlation coefficient and interobserver agreement was quantified with intraclass correlation coefficients (ICC). Results: Fourteen patients were included, of which 4 had congenitally corrected transposition of the great arteries (ccTGA) and 10 patients had TGA late after an atrial switch operation. Eight patients (57%) were female. There was a mean of 8 years between the first and second imaging assessment. Only global systemic RV function, fractional area change (FAC), and global longitudinal strain (GLS) were consistently, i.e., at both time points, correlated with CMR-RVEF (global RV function: r = -0.77/r = -0.63; FAC: r = 0.79/r = 0.67; GLS: r = -0.73/r = -0.70, all p-values < 0.05). The ICC of GLS (0.82 at t = 1, p = 0.006, 0.77 at t = 2, p = 0.024) was higher than the ICC of FAC (0.35 at t = 1, p = 0.196, 0.70 at t = 2, p = 0.051) at both time points. Conclusion: GLS appears to be the most robust echocardiographic measurement of systemic RV function with good correlation with CMR-RVEF and reproducibility.
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Affiliation(s)
- Tjitske E. Zandstra
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Monique R. M. Jongbloed
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Ralph L. Widya
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Eduard R. Holman
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Bart J. A. Mertens
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Hubert W. Vliegen
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Martin J. Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Philippine Kiès
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
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Venkatesh P, Evans AT, Maw AM, Pashun RA, Patel A, Kim L, Feldman D, Minutello R, Wong SC, Stribling JC, LaPar D, Holzer R, Ginns J, Bacha E, Singh HS. Predictors of Late Mortality in D-Transposition of the Great Arteries After Atrial Switch Repair: Systematic Review and Meta-Analysis. J Am Heart Assoc 2019; 8:e012932. [PMID: 31642369 PMCID: PMC6898856 DOI: 10.1161/jaha.119.012932] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Existing data on predictors of late mortality and prevention of sudden cardiac death after atrial switch repair surgery for D‐transposition of the great arteries (D‐TGA) are heterogeneous and limited by statistical power. Methods and Results We conducted a systematic review and meta‐analysis of 29 observational studies, comprising 5035 patients, that reported mortality after atrial switch repair with a minimum follow‐up of 10 years. We also examined 4 additional studies comprising 105 patients who reported rates of implantable cardioverter‐defibrillator therapy in this population. Average survival dropped to 65% at 40 years after atrial switch repair, with sudden cardiac death accounting for 45% of all reported deaths. Mortality was significantly lower in cohorts that were more recent and operated on younger patients. Patient‐level risk factors for late mortality were history of supraventricular tachycardia (odds ratio [OR] 3.8, 95% CI 1.4–10.7), Mustard procedure compared with Senning (OR 2.9, 95% CI 1.9–4.5) and complex D‐TGA compared with simple D‐TGA (OR 4.4, 95% CI 2.2–8.8). Significant risk factors for sudden cardiac death were history of supraventricular tachycardia (OR 4.7, 95% CI 2.2–9.8), Mustard procedure (OR 2.2, 95% CI 1.1–4.1), and complex D‐TGA (OR 5.7, 95% CI 1.8–18.0). Out of a total 124 implantable cardioverter‐defibrillator discharges over 330 patient‐years in patients with implantable cardioverter‐defibrillators for primary prevention, only 8% were appropriate. Conclusions Patient‐level risk of both mortality and sudden cardiac death after atrial switch repair are significantly increased by history of supraventricular tachycardia, Mustard procedure, and complex D‐TGA. This knowledge may help refine current selection practices for primary prevention implantable cardioverter‐defibrillator implantation, given disproportionately high rates of inappropriate discharges.
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Affiliation(s)
- Prashanth Venkatesh
- Division of Cardiology Departments of Medicine and Pediatrics Weill Cornell Medicine New York Presbyterian Hospital Cornell Center for Adult Congenital Heart Disease New York NY
| | - Arthur T Evans
- Division of Hospital Medicine Weill Cornell Medicine New York Presbyterian Hospital New York NY
| | - Anna M Maw
- Division of Hospital Medicine Weill Cornell Medicine New York Presbyterian Hospital New York NY
| | - Raymond A Pashun
- Division of Cardiology Departments of Medicine and Pediatrics Weill Cornell Medicine New York Presbyterian Hospital Cornell Center for Adult Congenital Heart Disease New York NY
| | - Agam Patel
- Division of Cardiology Departments of Medicine and Pediatrics Weill Cornell Medicine New York Presbyterian Hospital Cornell Center for Adult Congenital Heart Disease New York NY
| | - Luke Kim
- Division of Cardiology Departments of Medicine and Pediatrics Weill Cornell Medicine New York Presbyterian Hospital Cornell Center for Adult Congenital Heart Disease New York NY
| | - Dmitriy Feldman
- Division of Cardiology Departments of Medicine and Pediatrics Weill Cornell Medicine New York Presbyterian Hospital Cornell Center for Adult Congenital Heart Disease New York NY
| | - Robert Minutello
- Division of Cardiology Departments of Medicine and Pediatrics Weill Cornell Medicine New York Presbyterian Hospital Cornell Center for Adult Congenital Heart Disease New York NY
| | - S Chiu Wong
- Division of Cardiology Departments of Medicine and Pediatrics Weill Cornell Medicine New York Presbyterian Hospital Cornell Center for Adult Congenital Heart Disease New York NY
| | - Judy C Stribling
- Weill Cornell Medicine Samuel J. Wood Library Myra Mahon Patient Resource Center New York NY
| | - Damian LaPar
- Division of Cardiology Departments of Medicine and Pediatrics Weill Cornell Medicine New York Presbyterian Hospital Cornell Center for Adult Congenital Heart Disease New York NY
| | - Ralf Holzer
- Division of Cardiology Departments of Medicine and Pediatrics Weill Cornell Medicine New York Presbyterian Hospital Cornell Center for Adult Congenital Heart Disease New York NY
| | - Jonathan Ginns
- Division of Cardiology Departments of Medicine and Pediatrics Weill Cornell Medicine New York Presbyterian Hospital Cornell Center for Adult Congenital Heart Disease New York NY
| | - Emile Bacha
- Division of Cardiology Departments of Medicine and Pediatrics Weill Cornell Medicine New York Presbyterian Hospital Cornell Center for Adult Congenital Heart Disease New York NY
| | - Harsimran S Singh
- Division of Cardiology Departments of Medicine and Pediatrics Weill Cornell Medicine New York Presbyterian Hospital Cornell Center for Adult Congenital Heart Disease New York NY
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Rog B, Salapa K, Okolska M, Dluzniewska N, Werynski P, Podolec P, Tomkiewicz-Pajak L. Clinical Evaluation of Exercise Capacity in Adults with Systemic Right Ventricle. Tex Heart Inst J 2019; 46:14-20. [PMID: 30833832 DOI: 10.14503/thij-17-6408] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The right ventricle provides systemic circulation in individuals with congenitally corrected transposition of the great arteries (CCTGA) and in those with complete transposition who have had an atrial switch repair (DTGA). The aim of this study was to evaluate how the systemic right ventricle adapts to increased workload and oxygen demand during exercise. From November 2005 through December 2015, 3,358 adult patients with congenital heart disease were treated at our institution; we identified 48 (26 females, 22 males; median age, 25.4 ± 8.1 yr) who met the study criteria; 37 had DTGA and atrial switch repair, and 11 had CCTGA. We studied their echocardiographic and cardiopulmonary exercise test results. A control group consisted of 29 healthy sex- and age-matched volunteers. On exercise testing, oxygen uptake at anaerobic threshold, peak oxygen uptake, peak heart rate, and percentage of maximal heart rate were significantly lower in the group with systemic right ventricle than in the control group (all P <0.001); in contrast, the peak ventilatory equivalent for carbon dioxide was higher in the study group (P=0.013). Impaired systemic right ventricular function reduced peak oxygen uptake. The peak heart rate was lower in the CCTGA group than in the DTGA group. Our results indicate that reduced exercise capacity is related to impaired systemic right ventricular function, severe tricuspid valve regurgitation, and chronotropic incompetence. There was no correlation between cardiopulmonary exercise test results and time after surgery. Chronotropic efficiency is lower in individuals with CCTGA than in those with DTGA.
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7
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Chaix MA, Dore A, Marcotte F, Shohoudi A, Labombarda F, Mercier LA, Proietti A, Ibrahim R, Asgar AW, Mondésert B, Poirier N, Khairy P, Mongeon FP. Variability in the Echocardiographic Evaluation of the Systemic Right Ventricle. Can J Cardiol 2018; 35:178-184. [PMID: 30760424 DOI: 10.1016/j.cjca.2018.11.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/08/2018] [Accepted: 11/23/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Echocardiographic evaluation of the systemic right ventricle (sRV) remains challenging in patients with transposition of the great arteries (TGA) corrected by an atrial switch (AS) and with congenitally corrected TGA (ccTGA). The aim of this study was to determine the interobserver and intraobserver variability of echocardiographic parameters for sRV size and systolic function. METHODS Six independent observers retrospectively interpreted 44 previously acquired echocardiograms (25 patients with TGA/AS and 19 patients with ccTGA). Quantitative parameters included inlet and longitudinal diameters, systolic and diastolic areas, fractional area change (FAC), and wall thickness. sRV dilatation and systolic function were qualitatively graded as normal, mild, moderate, or severe. sRV hypertrophy was graded as present or absent. Intraclass correlation coefficients (ICCs) and Kappa statistics were computed to assess interobserver variability. Images from 10 patients (5 TGA/AS and 5 ccTGA) were reinterpreted at a 1-month interval, and ICC and Kendall tau b statistics were computed to assess intraobserver variability. RESULTS Interobserver and intraobserver agreement were good to excellent for sRV diameters, areas and FAC (ICC, 0.49-0.97), except for the sRV wall thickness (ICC < 0) and the FAC for 1 observer. Interobserver agreement was poor for the qualitative assessment of sRV size and systolic function (Kappa < 0.25), but with a good to excellent intraobserver agreement. CONCLUSIONS These findings suggest that overall appreciation of sRV size and systolic function relies on variable interpretation of measurements by observers. Readers experienced in CHD and with clear thresholds for quantitative parameters, along with a validated algorithm, are required to guide the evaluation of sRV.
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Affiliation(s)
- Marie-A Chaix
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Annie Dore
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - François Marcotte
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Azadeh Shohoudi
- Montreal Health Innovation Coordinating Center, Montréal, Quebec, Canada
| | - Fabien Labombarda
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Centre Hospitalier Universitaire de Caen, Université de Normandie, Caen, France
| | - Lise-Andrée Mercier
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Anna Proietti
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Réda Ibrahim
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Anita W Asgar
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Blandine Mondésert
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Nancy Poirier
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Paul Khairy
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - François-Pierre Mongeon
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
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8
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Storsten P, Eriksen M, Remme EW, Boe E, Erikssen G, Smiseth OA, Skulstad H. Dysfunction of the systemic right ventricle after atrial switch: physiological implications of altered septal geometry and load. J Appl Physiol (1985) 2018; 125:1482-1489. [DOI: 10.1152/japplphysiol.00255.2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Atrial switch operation in patients with transposition of the great arteries (TGA) leads to leftward shift and changes the geometry of the interventricular septum. By including the implications of regional work and septal curvature, this study investigates if changes in septal function and geometry contribute to reduced function of the systemic right ventricle (RV) in adult TGA patients. Regional myocardial work estimation has been possible by applying a recently developed method for noninvasive work calculation based on echocardiography. In 14 TGA patients (32 ± 6 yr, means ± SD) and 14 healthy controls, systemic ventricular systolic strains were measured by speckle tracking echocardiography and regional work was calculated by pressure-strain analysis. In TGA patients, septal longitudinal strain was reduced to −14 ± 2 vs. −20 ± 2% in controls ( P < 0.01) and septal work was reduced from 2,046 ± 318 to 1,146 ± 260 mmHg·% ( P < 0.01). Septal circumferential strain measured in a subgroup of patients was reduced to −11 ± 3 vs. −27 ± 3% in controls ( P < 0.01), and a reduction of septal work (540 ± 273 vs. 2,663 ± 459 mmHg·%) was seen ( P < 0.01). These reductions were in part attributed to elevated afterload due to increased radius of curvature of the leftward shifted septum. To conclude, in this mechanistic study we demonstrate that septal dysfunction contributes to failure of the systemic RV after atrial switch in TGA patients. This is potentially a long-term response to increased afterload due to a flatter septum and suggests that medical therapy that counteracts septal flattening may improve function of the systemic RV. NEW & NOTEWORTHY We have demonstrated that transposition of the great arteries patients with systemic right ventricles (RVs) have reduced function of the interventricular septum (IVS). Since the IVS is constructed to eject into the systemic circulation, it may seem unexpected that it does not maintain function when being part of the systemic RV. By applying the principles of regional work, wall tension, and geometry, we have identified unfavorable working conditions for the IVS when the RV adapts to systemic pressures.
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Affiliation(s)
- Petter Storsten
- Institute for Surgical Research, Oslo University Hospital, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
- Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine and University of Oslo, Oslo, Norway
| | - Morten Eriksen
- Institute for Surgical Research, Oslo University Hospital, Oslo, Norway
- Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway
| | - Espen W. Remme
- Institute for Surgical Research, Oslo University Hospital, Oslo, Norway
- Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway
- KG Jebsen Cardiac Research Center, University of Oslo, Oslo, Norway
| | - Espen Boe
- Institute for Surgical Research, Oslo University Hospital, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
- Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway
| | - Gunnar Erikssen
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Otto A. Smiseth
- Institute for Surgical Research, Oslo University Hospital, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
- Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway
- KG Jebsen Cardiac Research Center, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine and University of Oslo, Oslo, Norway
| | - Helge Skulstad
- Institute for Surgical Research, Oslo University Hospital, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
- Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine and University of Oslo, Oslo, Norway
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Morais H. Two-dimensional speckle tracking strain in follow-up of adults with transposition of the great arteries: Should it be used in daily clinical practice? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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10
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Morais H. Two-dimensional speckle tracking strain in follow-up of adults with transposition of the great arteries: Should it be used in daily clinical practice? Rev Port Cardiol 2018; 37:747-748. [PMID: 30143349 DOI: 10.1016/j.repc.2018.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Humberto Morais
- Departamento de Cardiologia, Hospital Militar Principal/Instituto Superior, Luanda, Angola.
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11
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Di Salvo G, Miller O, Babu Narayan S, Li W, Budts W, Valsangiacomo Buechel ER, Frigiola A, van den Bosch AE, Bonello B, Mertens L, Hussain T, Parish V, Habib G, Edvardsen T, Geva T, Baumgartner H, Gatzoulis MA, Delgado V, Haugaa KH, Lancellotti P, Flachskampf F, Cardim N, Gerber B, Masci PG, Donal E, Gimelli A, Muraru D, Cosyns B. Imaging the adult with congenital heart disease: a multimodality imaging approach—position paper from the EACVI. Eur Heart J Cardiovasc Imaging 2018; 19:1077-1098. [DOI: 10.1093/ehjci/jey102] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 06/28/2018] [Indexed: 12/18/2022] Open
Affiliation(s)
- Giovanni Di Salvo
- Department of Adult Congenital Heart Disease, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London, UK
| | - Owen Miller
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, UK
| | - Sonya Babu Narayan
- Department of Adult Congenital Heart Disease, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London, UK
| | - Wei Li
- Department of Adult Congenital Heart Disease, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London, UK
| | - Werner Budts
- Department Cardiovascular Sciences (KU Leuven), Congenital and Structural Cardiology (CSC UZ Leuven), Leuven, Belgium
| | | | - Alessandra Frigiola
- Adult Congenital Heart Disease, Guy's and St Thomas' Hospital, Westminster Bridge Road, London, UK
| | | | - Beatrice Bonello
- Department of Paediatric Cardiology, Great Ormond Street Hospital, London, UK
| | - Luc Mertens
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children and University of Toronto, SickKids, 555 University Avenue Toronto, Ontario, Canada
| | - Tarique Hussain
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
- Departments of Paediatrics, University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | | | - Gilbert Habib
- APHM, La Timone Hospital, Cardiology Department, Boulevard Jean Moulin, Marseille, France
| | - Thor Edvardsen
- Department of Cardiology, Sognsvannsveien 20, Oslo, Norvegia
| | - Tal Geva
- Department of Cardiology, 300 Longwood Avenue, Farley, Boston, Massachusetts, USA
| | | | - Michael A Gatzoulis
- Department of Adult Congenital Heart Disease, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London, UK
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12
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Assessment of transposition of the great arteries associated with multiple malformations using dual-source computed tomography. PLoS One 2017; 12:e0187578. [PMID: 29155835 PMCID: PMC5695805 DOI: 10.1371/journal.pone.0187578] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 10/19/2017] [Indexed: 02/05/2023] Open
Abstract
Purpose To determine the value of dual-source computed tomography (DSCT) in depicting the morphological characteristics and diagnosing the associated malformations for patients with transposition of the great arteries (TGA) before surgery. Materials and methods Twenty-five patients with TGA who underwent DSCT and transthoracic echocardiography (TTE) examination were retrospectively reviewed. The morphological types of TGA, the spatial relationship between the pulmonary artery and the aorta, as well as coronary artery-associated abnormalities were assessed by DSCT. In contrast to TTE, the diagnostic accuracy of associated malformations on DSCT were analyzed and calculated with reference to surgical or digital subtraction angiography (DSA) findings. Effective doses (EDs) were also calculated. Results Among the 25 patients, 12 (48%) had ventricular septal defects and left ventricular outflow tract stenosis. Sixteen patients (16/25, 64%) had great arteries with an oblique spatial relationship on DSCT. In addition, we found seven patients (7/25, 28%) with coronary artery malformation, including five with an abnormal coronary origin and two with signs of a myocardial bridge. According to DSA or surgical findings, DSCT was superior to TTE in demonstrating extracardiac anomalies (sensitivity, anomalies of great vessels: 100% vs. 93.33%, other anomalies: 100% vs. 46.15%). The mean estimated ED for those aged <10 years was <2 mSv (1.59 ± 0.95 mSv). Conclusions DSCT can achieve an overall assessment of patients with TGA, including any associated malformations as well as the identification of the spatial relationship of the great arteries. DSCT can therefore be considered as an alternative imaging modality for surgical decision making.
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13
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Vora MU, Christensen MJ, Markin NW. Perioperative Management of a Parturient After Atrial Switch Surgery for Dextro-Transposition of the Great Vessels. J Cardiothorac Vasc Anesth 2016; 31:669-674. [PMID: 27693205 DOI: 10.1053/j.jvca.2016.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Maulin U Vora
- University of Nebraska Medical Center, Omaha, Nebraska.
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14
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Markley RR, Ali A, Potfay J, Paulsen W, Jovin IS. Echocardiographic Evaluation of the Right Heart. J Cardiovasc Ultrasound 2016; 24:183-190. [PMID: 27721944 PMCID: PMC5050302 DOI: 10.4250/jcu.2016.24.3.183] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 05/03/2016] [Accepted: 07/26/2016] [Indexed: 12/23/2022] Open
Abstract
The appropriate use of echocardiography may reduce the need for invasive diagnostic cardiac procedures. The right side of the heart has recently gained interest among cardiologists as it became clear that abnormalities of the right heart morphology and function are associated with increased morbidity and mortality. Echocardiography is easy to perform, relatively cheap, readily available and do not pose the risk of ionizing radiation. Conventional 2D and, more recently, 3D echocardiography provides pertinent anatomic and physiologic information about the right side of the heart. Because of the advantages and simplicity of echocardiography it continues to be an excellent tool for evaluating the structure and function of the right side of the heart. This review outlines the uses of echocardiography in evaluating the right heart structure and function.
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Affiliation(s)
- Roshanak R Markley
- Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Asghar Ali
- Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA.; Department of Medicine, McGuire VA Medical Center, Richmond, VA, USA
| | - Jonathan Potfay
- Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA.; Department of Medicine, McGuire VA Medical Center, Richmond, VA, USA
| | - Walter Paulsen
- Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Ion S Jovin
- Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA.; Department of Medicine, McGuire VA Medical Center, Richmond, VA, USA
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15
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Goldberg DJ, French B, Szwast AL, McBride MG, Paridon SM, Rychik J, Mercer-Rosa L. Tricuspid annular plane systolic excursion correlates with exercise capacity in a cohort of patients with hypoplastic left heart syndrome after Fontan operation. Echocardiography 2016; 33:1897-1902. [PMID: 27596010 DOI: 10.1111/echo.13348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Tricuspid annular plane systolic excursion (TAPSE) is a reproducible measure of right ventricular systolic function. We sought to determine the reliability of TAPSE measurements, to evaluate TAPSE in patients with hypoplastic left heart syndrome (HLHS) relative to normal values, and to correlate values of TAPSE with measures of exercise performance. DESIGN Tricuspid annular plane systolic excursion measurements were performed off-line in the cohort of patients with single right ventricle anatomy who had been enrolled in the Sildenafil After Fontan Operation clinical trial. These values were converted to z-scores using age-specific means and standard deviations according to published reference values. Reproducibility of measurements was assessed using the coefficient of variation between two readers. Comparisons between echo measurements and exercise outcomes were assessed using Pearson correlation coefficients. RESULTS Forty-four echocardiograms from 11 subjects were included in this analysis. The median age of included subjects was 13 years (range 12-17). The coefficient of variation for TAPSE measurements was 5.0%. TAPSE was significantly diminished relative to reference values, with a median z-score of -7.6. TAPSE values correlated with both maximal oxygen consumption (R=.64; P=.033) and oxygen consumption at the anaerobic threshold (R=.73, P=.017). CONCLUSIONS In this small sample of children with HLHS, TAPSE was reproducible, substantially lower than reference values, and correlated well with measures of exercise performance. Further studies are needed to evaluate these findings in a larger cohort and in a longitudinal manner.
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Affiliation(s)
- David J Goldberg
- The Cardiac Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin French
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anita L Szwast
- The Cardiac Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael G McBride
- The Cardiac Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Stephen M Paridon
- The Cardiac Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jack Rychik
- The Cardiac Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Laura Mercer-Rosa
- The Cardiac Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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16
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Olmos-Temois SG, Santos-Martínez LE, Álvarez-Álvarez R, Gutiérrez-Delgado LG, Baranda-Tovar FM. Interobserver agreement on the echocardiographic parameters that estimate right ventricular systolic function in the early postoperative period of cardiac surgery. Med Intensiva 2016; 40:491-498. [PMID: 27198648 DOI: 10.1016/j.medin.2016.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 02/23/2016] [Accepted: 02/24/2016] [Indexed: 11/17/2022]
Abstract
PRIMARY OBJECTIVE To know the variability of transthoracic echocardiographic parameters that assess right ventricular systolic function by analyzing interobserver agreement in the early postoperative period of cardiovascular surgery. SECONDARY OBJECTIVE To assess the feasibility of these echocardiographic measurements. DESIGN A cross-sectional study, double-blind pilot study was carried out from May 2011 to February 2013. SETTING Cardiovascular postoperative critical care at the National Institute of Cardiology "Ignacio Chávez", Mexico City, Mexico. PATIENTS Consecutive, non-probabilistic sampling. Fifty-six patients were studied in the postoperative period of cardiac surgery. INTERVENTION The first echocardiographic parameters were obtained between 6-8hours after cardiac surgery, followed by blinded second measurements. MAIN VARIABLES Tricuspid annular plane systolic excursion (TAPSE), tricuspid annular peak systolic velocity on tissue Doppler imaging (VSPAT), diameters and right ventricular outflow area, tract fractional shortening. The agreement was analyzed by the Bland-Altman method, and its magnitude was assessed by the intraclass correlation coefficient (95% confidence interval). RESULTS Both observers evaluated TAPSE and VSPAT in 48 patients (92%). The average TAPSE was 11.68±4.53mm (range 4-27mm). Right ventricular systolic dysfunction was observed in 41 cases (85%) and normal TAPSE in 7 patients (15%). The average difference and its limits according to TAPSE were -0.917±2.95 (-6.821, 4.988), with a magnitude of 0.725 (0.552, 0.837); the tricuspid annular peak systolic velocity on tissue Doppler imaging was -0.001±0.015 (-0.031, 0.030), and its magnitude 0.825 (0.708, 0.898), respectively. CONCLUSIONS VSPAT and TAPSE were estimated by both observers in 92% of the patients, these parameters exhibiting the lowest interobserver variability.
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Affiliation(s)
- S G Olmos-Temois
- Departamento de Cuidados Intensivos Posquirúrgicos Cardiovasculares, Instituto Nacional de Cardiología «Ignacio Chávez», México D.F., México
| | - L E Santos-Martínez
- Unidad Médica de Alta Especialidad, Departamento de Hipertensión Pulmonar y Función Ventricular Derecha, Hospital de Cardiología del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social , México D.F., México; Departamento de Cuidados Intensivos Posquirúrgicos Cardiovasculares, Instituto Nacional de Cardiología «Ignacio Chávez», México D.F., México.
| | - R Álvarez-Álvarez
- Departamento de Cuidados Intensivos Posquirúrgicos Cardiovasculares, Instituto Nacional de Cardiología «Ignacio Chávez», México D.F., México
| | - L G Gutiérrez-Delgado
- Departamento de Cuidados Intensivos Posquirúrgicos Cardiovasculares, Instituto Nacional de Cardiología «Ignacio Chávez», México D.F., México
| | - F M Baranda-Tovar
- Departamento de Cuidados Intensivos Posquirúrgicos Cardiovasculares, Instituto Nacional de Cardiología «Ignacio Chávez», México D.F., México
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Longitudinal strain of systemic right ventricle correlates with exercise capacity in adult with transposition of the great arteries after atrial switch. Int J Cardiol 2016; 217:28-34. [PMID: 27179205 DOI: 10.1016/j.ijcard.2016.04.166] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 04/15/2016] [Accepted: 04/30/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Systemic right ventricle (sRV) dysfunction in d-transposition of the great arteries following atrial switch (d-TGA) is associated with increased mortality. We aimed to characterize maladaptive sRV mechanisms in d-TGA patients, analyzing relation of echocardiographic parameters of sRV systolic function to objective measurements of exercise capacity. METHODS Forty-seven adult patients with d-TGA and atrial switch (mean age 31.6±4.2years) underwent conventional echocardiography, bidimensional strain (2D-strain), cardiac magnetic resonance (CMR) imaging and cardiopulmonary exercise evaluation on the same day. Those with median peak oxygen uptake (VO2)>64.5% (n=23) constituted group A, those with VO2≤64.5% (n=24) constituted group B and 23 healthy age and gender matched subjects constituted the control group. RESULTS In group A, global longitudinal peak systolic 2D-strain (GLS) of sRV was significantly reduced compared to GLS of normal RV and LV in the healthy control group (p<0.01), however peak longitudinal 2D strain was similar at basal and mid-segment of sRV free wall than normal LV. In group B, GLS was significantly reduced compared to group A (-10.9±2.9% vs -13.1±2.3%, p<0.05), mostly due to significant decrease of interventricular septum longitudinal strain. Other echocardiographic systolic parameters were not significantly different between groups A and B. Only sRV GLS showed significant correlation with functional capacity as measured by VO2 (r=0.42, p<0.01), while CMR RVEF did not. CONCLUSION GLS of sRV predicts functional capacity and may be more sensitive than CMR RVEF in detecting early myocardial damage of sRV in patients with d-TGA and atrial switch.
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18
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Jorstig S, Waldenborg M, Lidén M, Wodecki M, Thunberg P. Determination of Right Ventricular Volume by Combining Echocardiographic Distance Measurements. Echocardiography 2016; 33:844-53. [PMID: 26841195 DOI: 10.1111/echo.13173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The position of the right ventricle (RV), often partly behind the sternum, implies difficulties to image the RV free wall using transthoracic echocardiography (TTE) and consequently limits the possibilities of stroke volume calculations. The aim of this study was to evaluate whether the volume of the right ventricle (RV) can be determined by combining TTE distance measurements that do not need the RV free wall to be fully visualized. METHODS The RV volume was approximated by an ellipsoid composed of three distances. Distance measurements, modeled RV stroke volumes (RVSV), and RV ejection fraction (RVEF) were compared to reference values obtained from cardiac magnetic resonance (CMR) imaging for 12 healthy volunteers. RESULTS Inter-modality comparisons showed that distance measurements were significantly underestimated in TTE compared to CMR. The modeled RV volumes using TTE distance measurements were underestimated compared to reference CMR volumes. There was, however, for TTE an agreement between modeled RVSV and left ventricular stroke volumes determined by biplane Simpson's rule. Similar agreement was shown between modeled RVSV based on CMR distance measurements and the CMR reference. Regarding RVEF, further studies including patients with a wider range of RVEF are needed to evaluate the method. CONCLUSION In conclusion, the ellipsoid model of the RV provides good estimates of RVSVs, but volumes based on distance measurements from different modalities cannot be used interchangeably.
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Affiliation(s)
- Stina Jorstig
- School of Health and Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Micael Waldenborg
- School of Health and Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of Clinical Physiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mats Lidén
- School of Health and Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of Radiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Maciej Wodecki
- Department of Clinical Physiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Per Thunberg
- School of Health and Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of Medical Physics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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19
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Quantification of systemic right ventricle by echocardiography. Arch Cardiovasc Dis 2016; 109:120-7. [PMID: 26850171 DOI: 10.1016/j.acvd.2015.11.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/05/2015] [Accepted: 11/11/2015] [Indexed: 11/20/2022]
Abstract
Improvements in cardiac imaging have recently focused a great interest on the right ventricle (RV). In patients with congenital heart disease, the right ventricle (RV) may support the systemic circulation (systemic RV). There are 2 different anatomic conditions providing such physiology: the congenitally corrected transposition of the great arteries (ccTGA) and the TGA surgically corrected by atrial switch. During the last decades, evidence is accumulating that progressive systemic RV failure develops leading to considerable morbidity and mortality. Various imaging modalities have been used to evaluate the systemic RV, but echocardiography is still predominantly used in clinical practice, allowing an anatomic and functional approach of the systemic RV function and the potential associated anomalies. The goal of this review is to offer a clinical perspective of the non-invasive evaluation of the systemic RV by echocardiography.
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20
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Hill GD, Frommelt PC, Stelter J, Campbell MJ, Cohen MS, Kharouf R, Lai WW, Levine JC, Lu JC, Menon SC, Slesnick TC, Wong PC, Saudek DE. Impact of initial norwood shunt type on right ventricular deformation: the single ventricle reconstruction trial. J Am Soc Echocardiogr 2015; 28:517-21. [PMID: 25690998 PMCID: PMC4426007 DOI: 10.1016/j.echo.2015.01.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Single Ventricle Reconstruction trial demonstrated a transplantation-free survival advantage at 12-month follow-up for patients with right ventricle-pulmonary artery shunts (RVPAS) with the Norwood procedure compared with modified Blalock-Taussig shunts but similar survival and decreased global right ventricular (RV) function on longer term follow-up. The impact of the required ventriculotomy for the RVPAS remains unknown. The aim of this study was to compare echocardiography-derived RV deformation indices after stage 2 procedures in survivors with single RV anomalies enrolled in the Single Ventricle Reconstruction trial. METHODS Global and regional RV systolic longitudinal and circumferential strain and strain rate, ejection fraction, and short-axis percentage fractional area change were all derived by speckle-tracking echocardiography from protocol echocardiograms obtained at 14.3 ± 1.2 months. Student t tests or Wilcoxon rank sum tests were used to compare groups. RESULTS The cohort included 275 subjects (129 in the modified Blalock-Taussig shunt group and 146 in the RVPAS group). Longitudinal deformation could be quantified in 214 subjects (78%) and circumferential measures in 182 subjects (66%). RV ejection fraction and percentage fractional area change did not differ between groups. There were no significant differences between groups for global or regional longitudinal deformation. Circumferential indices showed abnormalities in deformation in the RVPAS group, with decreased global circumferential strain (P = .05), strain rate (P = .09), and anterior regional strain rate (P = .07) that approached statistical significance. CONCLUSIONS RV myocardial deformation at 14 months, after stage 2 procedures, was not significantly altered by the type of initial shunt placed. However, abnormal trends were appreciated in circumferential deformation for the RVPAS group in the area of ventriculotomy that may represent early myocardial dysfunction. These data provide a basis for longer term RV deformation assessment in survivors after Norwood procedures.
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Affiliation(s)
| | | | | | | | - Meryl S Cohen
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rami Kharouf
- Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - Wyman W Lai
- Columbia University Medical Center, New York, New York
| | | | - Jimmy C Lu
- University of Michigan, Ann Arbor, Michigan
| | | | | | - Pierre C Wong
- Children's Hospital Los Angeles, Los Angeles, California
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Avitabile CM, Whitehead K, Fogel M, Mercer-Rosa L. Tricuspid annular plane systolic excursion does not correlate with right ventricular ejection fraction in patients with hypoplastic left heart syndrome after Fontan palliation. Pediatr Cardiol 2014; 35:1253-8. [PMID: 24840648 PMCID: PMC4440325 DOI: 10.1007/s00246-014-0924-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 04/25/2014] [Indexed: 11/29/2022]
Abstract
Tricuspid annular plane systolic excursion (TAPSE) reflects longitudinal myocardial shortening, the main component of right ventricular (RV) contraction in normal hearts. To date, TAPSE has not been extensively studied in patients with hypoplastic left heart syndrome (HLHS) and systemic RVs after Fontan palliation. This retrospective study investigated HLHS patients after Fontan with cardiac magnetic resonance (CMR) performed between 1 January 2010 and 1 August 2012 and transthoracic echocardiogram (TTE) performed within 6 months of CMR. The maximal apical displacement of the lateral tricuspid valve annulus was measured on CMR (using four-chamber cine images) and on TTE (using two-dimensional apical views). To create TTE-TAPSE z-scores, published reference data were used. Intra- and interobserver variability was tested with analysis of variance. Inter-technique agreement of TTE and CMR was tested with Bland-Altman analysis. In this study, 30 CMRs and TTEs from 29 patients were analyzed. The age at CMR was 14.1 ± 7.1 years, performed 11.9 ± 7.8 years after Fontan. For CMR-TAPSE, the intraclass correlation coefficients for inter- and intraobserver variability were 0.89 and 0.91, respectively. The TAPSE measurements were 0.57 ± 0.2 cm on CMR and 0.70 ± 0.2 cm on TTE (TTE-TAPSE z score, -8.7 ± 1.0). The mean difference in TAPSE between CMR and TTE was -0.13 cm [95 % confidence interval (CI) -0.21 to -0.05], with 95 % limits of agreement (-0.55 to 0.29 cm). The study showed no association between CMR-TAPSE and RVEF (R = 0.08; p = 0.67). In patients with HLHS after Fontan, TAPSE is reproducible on CMR and TTE, with good agreement between the two imaging methods. Diminished TAPSE suggests impaired longitudinal shortening in the systemic RV. However, TAPSE is not a surrogate for RVEF in this study population.
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Affiliation(s)
- Catherine M. Avitabile
- Division of Cardiology, The Children’s Hospital of Philadelphia, 8NW64, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Kevin Whitehead
- Division of Cardiology, The Children’s Hospital of Philadelphia, 8NW64, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 295 John Morgan Building, 3620 Hamilton Walk, Philadelphia, PA, USA
| | - Mark Fogel
- Division of Cardiology, The Children’s Hospital of Philadelphia, 8NW64, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 295 John Morgan Building, 3620 Hamilton Walk, Philadelphia, PA, USA
| | - Laura Mercer-Rosa
- Division of Cardiology, The Children’s Hospital of Philadelphia, 8NW64, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 295 John Morgan Building, 3620 Hamilton Walk, Philadelphia, PA, USA
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22
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Lewis M, Ginns J, Rosenbaum M. Is systemic right ventricular function by cardiac MRI related to the degree of tricuspid regurgitation in congenitally corrected transposition of the great arteries? Int J Cardiol 2014; 174:586-9. [PMID: 24814545 DOI: 10.1016/j.ijcard.2014.04.129] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 03/11/2014] [Accepted: 04/12/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND METHODS Systemic right ventricular dysfunction and tricuspid regurgitation (TR) are frequently encountered in patients with congenitally corrected transposition of the great arteries (CCTGA). Studies using echocardiography have suggested a relationship between the degree of TR and systemic right ventricular dysfunction; however, assessment of systemic right ventricular function by echocardiography is limited. Cardiac MRI (CMR) is the gold standard for volumetric assessment of the systemic right ventricle. We performed a retrospective cohort study at our center evaluating all adult patients with CCTGA who underwent a CMR between 1/1999 and 1/2013 to determine the relationship between the degree of TR and systemic right ventricular function. RESULTS Of the 33 patients identified, 12 had ≤ mild TR (37%), 13 had moderate TR (40%), and 8 had severe TR (24%). Mean age at CMR was 38 years (23-64). Mean right ventricular ejection fraction (45% vs. 41% vs. 42%, p=0.68) and mean indexed right ventricular end diastolic volume (122 ml/m(2) vs. 136 ml/m(2) vs. 138 ml/m(2)p=0.36) were not significantly different for patients with ≤ mild TR, moderate TR or severe TR. The degree of TR was not associated with additional congenital lesions, prior procedures, presence of an intraventricular conduction delay, or decreased left ventricular function. CONCLUSION No association between the degree of TR and right ventricular volume or ejection fraction by CMR was identified. Failure to show worsening function or increased volume with greater degrees of TR suggests that the degree of regurgitation alone may not fully explain the heterogeneity in right ventricular size and function.
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Affiliation(s)
- Matthew Lewis
- Division of Cardiology, Department of Medicine, Schneeweiss Adult Congenital Heart Center, Columbia University Medical Center, New York, NY, United States.
| | - Jonathan Ginns
- Division of Cardiology, Department of Medicine, Schneeweiss Adult Congenital Heart Center, Columbia University Medical Center, New York, NY, United States
| | - Marlon Rosenbaum
- Division of Cardiology, Department of Medicine, Schneeweiss Adult Congenital Heart Center, Columbia University Medical Center, New York, NY, United States
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Cuypers JAAE, Eindhoven JA, Slager MA, Opi P, Utens EMWJ, Helbing WA, Witsenburg M, van den Bosch AE, Ouhlous M, van Domburg RT, Rizopoulos D, Meijboom FJ, Bogers AJJC, Roos-Hesselink JW. The natural and unnatural history of the Mustard procedure: long-term outcome up to 40 years. Eur Heart J 2014; 35:1666-74. [DOI: 10.1093/eurheartj/ehu102] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bartels K, Karhausen J, Sullivan BL, Mackensen GB. Update on Perioperative Right Heart Assessment Using Transesophageal Echocardiography. Semin Cardiothorac Vasc Anesth 2014; 18:341-51. [DOI: 10.1177/1089253214522326] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose of the review. This review aims to summarize recent findings relevant for perioperative 2- and 3-dimensional imaging of the right heart with transesophageal echocardiography. Special attention is given to developments that are likely to affect future approaches for prevention and therapy of perioperative right heart failure. Recent findings. Three-dimensional transesophageal echocardiography techniques are becoming more common for the evaluation of anatomy, volumes, and functional indices. Summary. Right heart failure continues to contribute to morbidity and mortality in the context of cardiothoracic surgery. The advent and widespread clinical use of innovative tools permitting more accurate echocardiographic assessment of the right heart will open the door to renewed interest in novel therapeutic strategies.
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Affiliation(s)
- Karsten Bartels
- Department of Anesthesiology, University of Colorado Denver, Aurora, CO, USA
- Department of Anesthesiology, Duke University, Durham, NC, USA
| | - Jörn Karhausen
- Department of Anesthesiology, Duke University, Durham, NC, USA
| | | | - G. Burkhard Mackensen
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
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25
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Yeh DD, Foster E. Is MRI the Preferred Method for Evaluating Right Ventricular Size and Function in Patients With Congenital Heart Disease? Circ Cardiovasc Imaging 2014; 7:198-205. [DOI: 10.1161/circimaging.113.000395] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Doreen DeFaria Yeh
- From the Massachusetts General Hospital, Division of Cardiology, Adult Congenital Heart Disease Program, Echocardiography Section, Boston, MA (D.D.F.Y.); and University of California San Francisco, Director Non-Invasive Cardiology (E.F.)
| | - Elyse Foster
- From the Massachusetts General Hospital, Division of Cardiology, Adult Congenital Heart Disease Program, Echocardiography Section, Boston, MA (D.D.F.Y.); and University of California San Francisco, Director Non-Invasive Cardiology (E.F.)
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Cotts T, Khairy P, Opotowsky AR, John AS, Valente AM, Zaidi AN, Cook SC, Aboulhosn J, Ting JG, Gurvitz M, Landzberg MJ, Verstappen A, Kay J, Earing M, Franklin W, Kogon B, Broberg CS. Clinical research priorities in adult congenital heart disease. Int J Cardiol 2013; 171:351-60. [PMID: 24411207 DOI: 10.1016/j.ijcard.2013.12.034] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 12/14/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Adult congenital heart disease (ACHD) clinicians are hampered by the paucity of data to inform clinical decision-making. The objective of this study was to identify priorities for clinical research in ACHD. METHODS A list of 45 research questions was developed by the Alliance for Adult Research in Congenital Cardiology (AARCC), compiled into a survey, and administered to ACHD providers. Patient input was sought via the Adult Congenital Heart Association at community meetings and online forums. The 25 top questions were sent to ACHD providers worldwide via an online survey. Each question was ranked based on perceived priority and weighted based on time spent in ACHD care. The top 10 topics identified are presented and discussed. RESULTS The final online survey yielded 139 responses. Top priority questions related to tetralogy of Fallot (timing of pulmonary valve replacement and criteria for primary prevention ICDs), patients with systemic right ventricles (determining the optimal echocardiographic techniques for measuring right ventricular function, and indications for tricuspid valve replacement and primary prevention ICDs), and single ventricle/Fontan patients (role of pulmonary vasodilators, optimal anticoagulation, medical therapy for preservation of ventricular function, treatment for protein losing enteropathy). In addition, establishing criteria to refer ACHD patients for cardiac transplantation was deemed a priority. CONCLUSIONS The ACHD field is in need of prospective research to address fundamental clinical questions. It is hoped that this methodical consultation process will inform researchers and funding organizations about clinical research topics deemed to be of high priority.
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Affiliation(s)
- Timothy Cotts
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States; Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, United States.
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Alexander R Opotowsky
- Boston Children's Hospital, Department of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Anitha S John
- Division of Cardiology, Children's National Medical Center, Washington, D.C., United States
| | - Anne Marie Valente
- Boston Children's Hospital, Department of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Ali N Zaidi
- Columbus Ohio Adult Congenital Heart Disease Program, The Heart Center, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, United States; Department of Pediatrics, The Ohio State University, Columbus, OH, United States; Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Stephen C Cook
- Department of Pediatrics, Heart Institute, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, United States
| | - Jamil Aboulhosn
- Department of Internal Medicine, University of California, Los Angeles, CA, United States
| | - Jennifer Grando Ting
- Heart & Vascular Institute, Hershey Medical Center, Pennsylvania State University, Hershey, PA, United States
| | - Michelle Gurvitz
- Boston Children's Hospital, Department of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Michael J Landzberg
- Boston Children's Hospital, Department of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Amy Verstappen
- Adult Congenital Heart Association, Philadelphia, PA, United States
| | - Joseph Kay
- Department of Internal Medicine, University of Colorado, Denver, United States; Department of Pediatrics, University of Colorado, Denver, United States
| | - Michael Earing
- Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, United States; Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Wayne Franklin
- Department of Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States; Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States
| | - Brian Kogon
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, United States
| | - Craig S Broberg
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, United States
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De Caro E, Bondanza S, Calevo MG, Trocchio G, Lupi G, Domenicucci S, Marasini M. Tricuspid annular plane systolic excursion for the assessment of ventricular function in adults operated on with mustard procedure for complete transposition of the great arteries. CONGENIT HEART DIS 2013; 9:252-8. [PMID: 24010728 DOI: 10.1111/chd.12135] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND In adult patients with d-transposition of the great arteries after atrial switch operation, dysfunction of the systemic right ventricle (RV) is a well-known complication. Echocardiographic variables may provide adequate estimation of subpulmonary RV function, but their applicability to the subaortic RV is not straightforward. We evaluate the concordance between tricuspid annular plane systolic excursion (TAPSE) and magnetic resonance imaging-derived ejection fraction of the RV (MRI-RVEF) in these patients. METHODS Patients were recruited from those evaluated at the adult congenital clinic of our department between 2010 and 2012. All patients who had an echocardiographic assessment within 6 months of their MRI examination were selected. Patients clinically unstable, not in sinus rhythm, with a prosthetic systemic atrioventricular valve, permanent pacemaker, or more than moderate systemic atrioventricular valve regurgitation were excluded. RESULTS Eighteen Mustard-operated patients aged 22 ± 3.7 years were studied. The mean values of TAPSE and RVEF were 13.22 ± 1.7 mm and 49.7 ± 6%, respectively. TAPSE and RVEF were normal in 1 (5.5%) and 10 (55.5%) patients, respectively. Seventeen (94.4%) patients showed reduced TAPSE (12.9 ± 1.3 mm): RVEF was reduced in eight (47%) of these subjects, and normal in nine (53%). In patients with normal RVEF, both the MRI-RV end-diastolic and the MRI-RV end-systolic volumes were significantly lower than in patients with reduced RVEF. There were no other statistically significant differences between these patients. No correlation was found between TAPSE and both the MRI-RV end-diastolic and the end-systolic volumes. Globally, agreement between TAPSE and RVEF was slight (K = 0.09 ± 0.089). CONCLUSIONS Our results indicate that in these patients TAPSE is not a useful measure of RV function.
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Affiliation(s)
- Enrico De Caro
- Department of Cardiology, Istituto Giannina Gaslini, Genoa, Italy
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Orwat S, Diller GP, Baumgartner H. Imaging of congenital heart disease in adults: choice of modalities. Eur Heart J Cardiovasc Imaging 2013; 15:6-17. [PMID: 23913331 DOI: 10.1093/ehjci/jet124] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Major advances in noninvasive imaging of adult congenital heart disease have been accomplished. These tools play now a key role in comprehensive diagnostic work-up, decision for intervention, evaluation for the suitability of specific therapeutic options, monitoring of interventions and regular follow-up. Besides echocardiography, magnetic resonance (CMR) and computed tomography (CT) have gained particular importance. The choice of imaging modality has thus become a critical issue. This review summarizes strengths and limitations of the different imaging modalities and how they may be used in a complementary fashion. Echocardiography obviously remains the workhorse of imaging routinely used in all patients. However, in complex disease and after surgery echocardiography alone frequently remains insufficient. CMR is particularly useful in this setting and allows reproducible and accurate quantification of ventricular function and comprehensive assessment of cardiac anatomy, aorta, pulmonary arteries and venous return including complex flow measurements. CT is preferred when CMR is contraindicated, when superior spatial resolution is required or when "metallic" artefacts limit CMR imaging. In conclusion, the use of currently available imaging modalities in adult congenital heart disease needs to be complementary. Echocardiography remains the basis tool, CMR and CT should be added considering specific open questions and the ability to answer them, availability and economic issues.
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Affiliation(s)
- Stefan Orwat
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Albert-Schweitzer-Str. 33, Muenster 48149, Germany
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