1
|
Leonardi B, Perrone M, Calcaterra G, Sabatino J, Leo I, Aversani M, Bassareo PP, Pozza A, Oreto L, Moscatelli S, Borrelli N, Bianco F, Di Salvo G. Repaired Tetralogy of Fallot: Have We Understood the Right Timing of PVR? J Clin Med 2024; 13:2682. [PMID: 38731211 PMCID: PMC11084704 DOI: 10.3390/jcm13092682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/23/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
Despite many advances in surgical repair during the past few decades, the majority of tetralogy of Fallot patients continue to experience residual hemodynamic and electrophysiological abnormalities. The actual issue, which has yet to be solved, is understanding how this disease evolves in each individual patient and, as a result, who is truly at risk of sudden death, as well as the proper timing of pulmonary valve replacement (PVR). Our responsibility should be to select the most appropriate time for each patient, going above and beyond imaging criteria used up to now to make such a clinically crucial decision. Despite several studies on timing, indications, procedures, and outcomes of PVR, there is still much uncertainty about whether PVR reduces arrhythmia burden or improves survival in these patients and how to appropriately manage this population. This review summarizes the most recent research on the evolution of repaired tetralogy of Fallot (from adolescence onwards) and risk factor variables that may favor or delay PVR.
Collapse
Affiliation(s)
| | - Marco Perrone
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
- Division of Cardiology and CardioLab, Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | | | - Jolanda Sabatino
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (J.S.); (I.L.)
| | - Isabella Leo
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (J.S.); (I.L.)
| | - Martina Aversani
- Paediatric Cardiology and Congenital Heart Disease, University of Padua and Pediatric Research Institute (IRP), Città Della Speranza, 35127 Padua, Italy; (M.A.); (G.D.S.)
| | - Pier Paolo Bassareo
- School of Medicine, University College of Dublin, Mater Misericordiae University Hospital, D07 R2WY Dublin, Ireland;
| | - Alice Pozza
- Paediatric Cardiology and Congenital Heart Disease, University of Padua and Pediatric Research Institute (IRP), Città Della Speranza, 35127 Padua, Italy; (M.A.); (G.D.S.)
| | - Lilia Oreto
- Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, 98122 Messina, Italy;
| | - Sara Moscatelli
- Institute of Cardiovascular Sciences University College London, London WC1E 6BT, UK and Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK;
| | - Nunzia Borrelli
- Adult Congenital Heart Disease Unit, AO Dei Colli, Monaldi Hospital, 80131 Naples, Italy;
| | - Francesco Bianco
- Cardiovascular Sciences Department, AOU “Ospedali Riuniti”, 60126 Ancona, Italy;
| | - Giovanni Di Salvo
- Paediatric Cardiology and Congenital Heart Disease, University of Padua and Pediatric Research Institute (IRP), Città Della Speranza, 35127 Padua, Italy; (M.A.); (G.D.S.)
| |
Collapse
|
2
|
Manukyan SN, Soynov IA, Voytov AV, Rzaeva KA, Baranov AA, Bogachev-Prokofiev AV. [Modern possibilities for transcatheter pulmonary valve replacement]. Khirurgiia (Mosk) 2024:32-44. [PMID: 38344958 DOI: 10.17116/hirurgia202402132] [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] [Indexed: 02/15/2024]
Abstract
The literature review is devoted to transcatheter pulmonary valve replacement. The authors summarize the indications, clinical data and current capabilities of transcatheter pulmonary valve replacement. The authors also overviewed modern valves for transcatheter pulmonary artery replacement. Effectiveness of transcatheter pulmonary valve implantation has been substantiated. Various studies comparing the outcomes of different valve systems for endovascular implantation were analyzed. The authors concluded the prospects for transcatheter pulmonary valve implantation.
Collapse
Affiliation(s)
- S N Manukyan
- Meshalkin National Medical Research, Novosibirsk, Russia
| | - I A Soynov
- Meshalkin National Medical Research, Novosibirsk, Russia
| | - A V Voytov
- Meshalkin National Medical Research, Novosibirsk, Russia
| | - K A Rzaeva
- Meshalkin National Medical Research, Novosibirsk, Russia
| | - A A Baranov
- Meshalkin National Medical Research, Novosibirsk, Russia
| | | |
Collapse
|
3
|
Bou Chaaya RG, Barron E, Herrmann JL, Brown JW, Ephrem G. QRS Duration After Pulmonary Valve Replacement in Adults with Repaired Tetralogy of Fallot: Association with Ventricular Arrhythmia and Correlation with Right Ventricular Size. Pediatr Cardiol 2023; 44:1658-1666. [PMID: 37624409 DOI: 10.1007/s00246-023-03272-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023]
Abstract
The aim of this study is to analyze the relationship between QRS duration after pulmonary valve replacement (PVR) and ventricular arrhythmias (VA) in patients with repaired tetralogy of Fallot (ToF). ToF patients may face complications such as heart failure and VA after primary repair, often mitigated by PVR. Prior studies have shown a decrease in QRS duration and right ventricular (RV) size following PVR. It remains unclear whether a lack of QRS duration reduction identifies patients at risk of VA. We retrospectively identified adult patients with repaired ToF who underwent surgical or transcatheter PVR. EKG data (pre-PVR, 30 days to 1-year post-PVR, and closest to CMR) was collected. The primary endpoint was sustained ventricular tachycardia (VT), ICD shock for sustained VT, or inducible VT on EP study. 85 patients were included (median follow-up 3.6 years; median age 34 years; 51% females). The primary outcome was noted in 8 patients. Mean QRS duration decreased by 5 ms following PVR (p = 0.0001). Increased age at PVR, QRS ≥ 180 ms post-PVR, no reduction in QRS after PVR, and a history of VT were associated with higher risk of the primary endpoint. The change in QRS was linearly correlated with the change in RVEDVi (R = 0.66). Adults with repaired ToF experience a reduction in QRS duration post-PVR that correlates with the change of the RV size. Patients with QRS ≥ 180 ms post-PVR, no reduction in QRS, increased age at repair, and a history of VT are at risk for recurrent VT and warrant closer monitoring/ICD consideration.
Collapse
Affiliation(s)
- Rody G Bou Chaaya
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA.
| | - Emily Barron
- Cardiovascular Institute, Indiana University School of Medicine, Indiana University Health, Indianapolis, IN, USA
| | - Jeremy L Herrmann
- Section of Pediatric Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- Riley Children's Health, Indiana University Health, Indianapolis, IN, USA
| | - John W Brown
- Section of Pediatric Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- Riley Children's Health, Indiana University Health, Indianapolis, IN, USA
| | - Georges Ephrem
- University of Tennessee Health Science Center, Memphis, TN, USA
| |
Collapse
|
4
|
Bitterman Y, Hui W, Fan CPS, Kiss A, Mertens L, Wald RM, Friedberg MK. Electromechanical Dyssynchrony Is Associated With Right Ventricular Remodeling and Dysfunction Independently of Pulmonary Regurgitation Late After Tetralogy of Fallot Repair. J Am Soc Echocardiogr 2023; 36:1315-1323. [PMID: 37356675 DOI: 10.1016/j.echo.2023.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 05/31/2023] [Accepted: 06/13/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND The aim of this study was to investigate the relationship among right ventricular (RV) dilatation, dysfunction, and electromechanical dyssynchrony (EMD) in patients with repaired tetralogy of Fallot (rTOF). METHODS Data from a prospective rTOF registry of subjects with moderate or greater pulmonary regurgitation (PR) and contemporary imaging were analyzed. Electrocardiograms and echocardiograms were analyzed for EMD (prolonged QRS duration [QRSd], echocardiographic septal flash, and mechanical delay) and mechanical dispersion. The relationship among these, RV measurements on cardiac magnetic resonance, exercise capacity, and incident arrhythmia or death was analyzed with adjustment for PR. RESULTS In total, 271 patients with rTOF (42% women; median age, 32 years; interquartile range [IQR], 23-34 years) were included. Patients had moderate to severe PR (median PR fraction, 38%; IQR, 30%-47%), moderate to severe RV enlargement (median RV end-diastolic volume index, 161 mL/m2; IQR, 138-186 mL/m2) and mild RV systolic dysfunction (median RV ejection fraction [RVEF], 44%; IQR, 38%-48%). Eleven patients (4%) experienced ventricular arrhythmia or death. Presence of EMD was associated with larger RV size (RV end-diastolic volume index and RV end-systolic volume index, P = .006 and P < .001, respectively) and lower RVEF (P < .001). A sharp inflection in the relation among QRSd, RV size, and RVEF was observed when QRSd exceeded 150 msec (3.1% decrease in RVEF for every 20-msec increase in QRSd between 160 and 200 msec). Similar inflection points were observed for the mechanical delay between the RV basal-lateral and midseptal segments. The mechanical delay was higher in patients with vs without incident atrial arrhythmia (371 vs 276 msec, P = .014). CONCLUSIONS In adults with rTOF, EMD is independently associated with larger RV size, lower RVEF, and incident atrial arrhythmias.
Collapse
Affiliation(s)
- Yuval Bitterman
- Labatt Family Heart Centre, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Wei Hui
- Labatt Family Heart Centre, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Chun-Po Steve Fan
- Ted Rogers Computational Program, Ted Rogers Center for Heart Research, The Hospital for Sick Children, University Health Network, Toronto, Ontario, Canada
| | - Andreea Kiss
- Toronto General Hospital/University Health Network, Toronto, Ontario, Canada
| | - Luc Mertens
- Labatt Family Heart Centre, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rachel M Wald
- Toronto General Hospital/University Health Network, Toronto, Ontario, Canada
| | - Mark K Friedberg
- Labatt Family Heart Centre, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
| |
Collapse
|
5
|
Slouha E, Trygg G, Tariq AH, La A, Shay A, Gorantla VR. Pulmonary Valve Replacement Timing Following Initial Tetralogy of Fallot Repair: A Systematic Review. Cureus 2023; 15:e49577. [PMID: 38156158 PMCID: PMC10754298 DOI: 10.7759/cureus.49577] [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] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
Pulmonary valve replacement (PVR) is a critical aspect of surgical management for patients with tetralogy of Fallot (ToF). Determining an optimal timeframe for intervention is imperative, as it directly impacts long-term outcomes and the risk of complications in ToF patients. Ventriculotomy with the transannular patch is currently indicated for right ventricular outflow tract obstruction, but the patch itself can lead to pulmonary regurgitation (PR), dyspnea, and cyanosis, among other complications. This investigation seeks to establish an evidence-based timeline to enhance the overall quality of care for individuals with this congenital heart condition. From 2002 to 2022, 21,935 articles regarding the PVR timing for ToF were examined and filtered. The publications were screened using PRISMA guidelines, and 32 studies were included for analysis and review. Among the studies, PVR was strongly indicated for patients who had developed severe PR, especially in asymptomatic patients and those experiencing fatigue and exercise intolerance. Severe PR was associated with arrhythmias such as right bundle branch block, atrioventricular block, and prolonged QRS intervals, in which male sex and high right ventricular end-diastolic volume (RVEDV) were significant predictors of long preoperative QRS duration. Most physicians found RVEDV necessary for making surgical referrals despite a lack of correlation between PR severity and RVEDV or indexed right ventricular end-systolic volume (RVESVi). However, asymptomatic ToF patients with preoperative RVESVi benefited from PVR. Except for some variations in QRS intervals among studies, arrhythmias tended to persist post-op, yet NYHA functional class and RV size improved significantly following PVR. Older age at PVR was found to be associated with adverse cardiac events, whereas early PVR presented with appropriately short QRS intervals. Cardiac function tended to be significantly worse in patients undergoing late PVR versus early PVR, with timelines ranging from one to three decades following initial ToF repair. Choosing the best timeline for PVR largely depends on the patient's baseline cardiopulmonary presentation, and additional quantitative deformation analysis can help predict an appropriate timeline for ToF patients.
Collapse
Affiliation(s)
- Ethan Slouha
- Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Genevieve Trygg
- Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Abdul Hadi Tariq
- Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Anthony La
- Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Allison Shay
- Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Vasavi R Gorantla
- Biomedical Sciences, West Virginia School of Osteopathic Medicine, Lewisburg, USA
| |
Collapse
|
6
|
Helal AM, Baho HA, Elmahrouk AF, Mashali MH. PR and QRS interval changes after transcatheter pulmonary valve replacement in children. Egypt Heart J 2023; 75:66. [PMID: 37486586 PMCID: PMC10366049 DOI: 10.1186/s43044-023-00394-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/20/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Changes in PR intervals after transcatheter pulmonary valve replacement (TCPVR) have not been thoroughly evaluated in children. This study evaluated the changes in PR and QRS intervals six months after TCPVR in children with congenital heart disease. RESULTS This study included 41 patients who underwent TCPVR from 2010 to 2022. ECG of patients was reviewed before and six months after TCPVR, and the PR and QRS intervals were reported. Right ventricular systolic pressure (RVSP) was retrieved indirectly from echocardiography and compared pre- and 6-months after TPVR. The median age was 13 years (25th-75th percentiles: 11-16), and 61% were males. The preoperative diagnosis was tetralogy of Fallot (n = 29, 71%), transposition of great vessels (n = 4, 10%), common arterial trunk (n = 3, 7%), pulmonary valve stenosis (n = 3, 7%) and pulmonary atresia (n = 2, 5%). The Melody valve was used in 30 patients, and Edwards Sapien was used in 11 patients. RVSP was significantly reduced six months after the procedure (pre-RVSP 40 (30-55) mmHg vs. post-RVSP 25 (20-35) mmHg; P < 0.001). The PR interval was 142 (132-174) msec before TPVR and 146 (132-168) msec post-TCPVR (P = 0.442). Post-TPVR PR was positively related to the pre-PR (β: 0.79 (0.66-0.93), P < 0.001) and inversely related to the right ventricular outflow tract size (- 1.48 (- 2.76 to - 0.21), P = 0.023). The pre-TPVR QRS was 130 (102-146) msec, and the post-TPVR QRS was 136 (106-144) msec (P = 0.668). CONCLUSIONS In children undergoing TCPVR, the PR and QRS intervals did not change significantly during a 6-month follow-up.
Collapse
Affiliation(s)
- Abdelmonem M Helal
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- Department of Pediatrics, Pediatric Cardiology Division, Cairo University, Cairo, Egypt
| | - Haysam A Baho
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed F Elmahrouk
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box:40047, 21499, Jeddah, Saudi Arabia.
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt.
| | - Mohamed H Mashali
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- Department of Pediatrics, Pediatric Cardiology Division, Cairo University, Cairo, Egypt
| |
Collapse
|
7
|
Is the QRS duration useful for determining the optimal timing of pulmonary valve replacement after tetralogy of Fallot repair? Gen Thorac Cardiovasc Surg 2022:10.1007/s11748-022-01898-0. [DOI: 10.1007/s11748-022-01898-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
|
8
|
Zhuang B, Yu S, Feng Z, He F, Jiang Y, Zhao S, Lu M, Li S. Left ventricular strain derived from cardiac magnetic resonance can predict outcomes of pulmonary valve replacement in patients with repaired tetralogy of Fallot. Front Cardiovasc Med 2022; 9:917026. [PMID: 36061553 PMCID: PMC9433663 DOI: 10.3389/fcvm.2022.917026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeSeveral adults with repaired tetralogy of Fallot (rToF) undergo pulmonary valve replacement (PVR) to reduce the right ventricular volume and retain right ventricular function. However, there is currently no consensus on the ideal time for PVR surgery in asymptomatic patients with rTOF with pulmonary regurgitation (PR). Clinical outcomes after PVR are also indeterminate. Recently, myocardial strain and strain rate derived from cardiac magnetic resonance (CMR) feature tracking were found to be more sensitive to right ventricular dysfunction than conventional parameters and therefore may add prognostic value in patients with rToF. We aimed to analyze whether pre-PVR left ventricular (LV) strain and strain rate detected by CMR feature tracking are associated with midterm outcomes after PVR in patients with rToF.MethodsSeventy-eight asymptomatic patients with rToF who required PVR due to moderate or severe PR were prospectively enrolled between January 2014 and June 2020. CMR cine sequences were obtained, and feature tracking parameters were measured preoperatively. Adverse events were documented during the follow-up. Receiver operating characteristic analysis was performed to determine the cutoff value. Kaplan–Meier curves were drawn with log-rank statistics; moreover, univariate and multivariate Cox proportional hazards regression analyses and Harrel C-indices were analyzed.ResultsDuring 3.6 ± 1.8 years of follow-up, 25 adverse events were recorded. Kaplan–Meier survival curves and univariate Cox analysis verified that patients with significantly reduced radial strain (RS), circumferential strain (CS), longitudinal strain (LS), RS rate at systole and diastole (RSRs and RSRe), and circumferential and LS rates at diastole (CSRe and LSRe) had worse event-free survival. After multivariate correction, only LS and LSRe remained significantly associated with adverse outcomes (hazard ratio = 1.243 [1.083–1.428] and 0.067 [0.017–0.258], respectively, all p < 0.05). The cutoff values of LS and LSRe were −12.30 (%) and 1.07 (s–1), respectively.ConclusionThe LV strain and strain rate prior to PVR are important prognostic factors for adverse events after PVR in rToF.
Collapse
Affiliation(s)
- Baiyan Zhuang
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shiqin Yu
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zicong Feng
- Pediatric Cardiac Surgery Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengpu He
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Yong Jiang
- Department of Echocardiography, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Echocardiography, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, China
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Minjie Lu,
| | - Shoujun Li
- Pediatric Cardiac Surgery Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Shoujun Li,
| |
Collapse
|
9
|
Jain A, Rajan SK, Patel K, Garg P, Agrawal V, Kakkar D, Gajjar T, Mishra A, Patel S, Doshi C. Concomitant pulmonary valve replacement with intracardiac repair for adult tetralogy of Fallot. Ann Pediatr Cardiol 2021; 14:323-330. [PMID: 34667403 PMCID: PMC8457283 DOI: 10.4103/apc.apc_125_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/18/2020] [Accepted: 05/27/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives : Adult patients undergoing tetralogy of Fallot (TOF) repair have a higher risk of mortality compared to pediatric patients. Pulmonary regurgitation (PR) further predisposes these patients to heart failure, arrhythmias, and sudden death. Pulmonary valve replacement (PVR) may improve the symptoms in these patients but, fails to reverse the other deleterious effects. Aim of our study was to evaluate the effect of concomitant PVR with TOF repair on right ventricular (RV) parameters, cardiopulmonary exercise capacity, and bioprosthetic valve durability at mid-term. Materials and Methods: Between January 2013 and August 2018, 37 adolescents and adults with TOF who had hypoplastic pulmonary annulus underwent concomitant TOF repair with PVR at our institute. We retrospectively collected the data from the hospital records including follow-up. Results : Mean age of the patients was 18.48 ± 7.53 years. Bioprosthetic valve size ranged from 19 mm to 25 mm. There was no early or late mortality. No patient had developed significant perioperative complications. At a mean follow-up of 53.3 ± 16.4 months, there was no significant change in mean QRS duration, RV function, RV end-systolic and end-diastolic dimensions, RV myocardial performance index, and functional status (including NYHA class and 6-min walk test) compared to at-discharge values. Four patients developed prosthetic valve degeneration with mild PR and without significant increase in gradient. Conclusion : Concomitant PVR with TOF repair in adult provides excellent mid-term outcome, with a minimal rate of pulmonary valve degeneration. It not only eases the early postoperative course but also preserves the RV function as well as functional status at mid-term.
Collapse
Affiliation(s)
- Anil Jain
- Department of Cardio Vascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Suresh Kumar Rajan
- Department of Cardio Vascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Kartik Patel
- Department of Cardio Vascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Pankaj Garg
- Department of Cardio Vascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Vishal Agrawal
- Department of Cardio Vascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Deepti Kakkar
- Department of Cardio Vascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Trushar Gajjar
- Department of Pediatric Cardiac Surgery, U.N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Amit Mishra
- Department of Pediatric Cardiac Surgery, U.N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Sanjay Patel
- Department of Research, U.N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Chirag Doshi
- Department of Cardio Vascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| |
Collapse
|
10
|
The Predicament of Surgical Correction of Tetralogy of Fallot. Pediatr Cardiol 2021; 42:1252-1257. [PMID: 34175987 DOI: 10.1007/s00246-021-02662-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/08/2021] [Indexed: 10/21/2022]
Abstract
Surgery for tetralogy of Fallot has a long history, which may be described as both a success story and a failure story. It is a success story because prognosis without surgery is very poor, but surgery makes it possible for affected babies to reach adulthood and lead productive lives. It is a failure story, however, since we still cannot cure this condition; we can only palliate it as illustrated in the sobering long-term outcome of affected patients. In this review article, we aim to explore the reason for this failure. This may be summed up in terms of the nature of the obstruction to the right ventricular outflow tract, which characterizes this malformation and must be relieved. This obstruction has several possible components, but none may be eliminated without harming the ventricle. There seems to be no 'extra' muscle band in tetralogy of Fallot that may be dispensed with without undermining ventricular function; every muscle band that is there should be there, just like in the normal heart, except that these are thicker than normal and somewhat displaced in tetralogy of Fallot, thus narrowing the right ventricular outflow tract. Consequently, ventricular function deteriorates with every muscle band that is cut, just like in the normal heart. We have to harm the heart in order to repair it. Every repaired Fallot is inevitably a damaged heart. Consequently, repair of this condition cannot be curative at present; it is palliative surgery.
Collapse
|
11
|
Romeo JLR, Takkenberg JJM, Cuypers JAAE, de Groot NMS, van de Woestijne P, Bruining N, Bogers AJJC, Mokhles MM. Timing of pulmonary valve replacement in patients with corrected Fallot to prevent QRS prolongation. Eur J Cardiothorac Surg 2021; 58:559-566. [PMID: 32191321 PMCID: PMC7453033 DOI: 10.1093/ejcts/ezaa049] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/11/2020] [Accepted: 01/23/2020] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES Timing of pulmonary valve replacement (PVR) remains one of the most heavily debated topics in congenital cardiac surgery. We aimed to analyse the temporal evolution of QRS duration before and after PVR. METHODS We included 158 consecutive patients who underwent PVR after previous correction with transannular patch. All 3549 available serial standard 12-lead surface QRS measurements of 158 (100%) patients were analysed with linear mixed-effect modelling. RESULTS PVR was performed at a mean age of 28.0 ± 10.7 years, 23.4 ± 8.4 years after correction. Hospital survival was 98.1%. A longer time interval between ToF correction and PVR (P < 0.001), and an older age at correction (P = 0.015) were predictive of progressive QRS prolongation after PVR. Women on average had a shorter QRS duration (P = 0.005) after PVR. The model predicted that in patients corrected early (model age 0.5 years), PVR within 17 years after correction leads to narrowing or stabilization of QRS width. PVR beyond 17 years was associated with prolongation of QRS duration. In a patient corrected late (model age 5 years), PVR has to be performed within 15 years after correction to prevent prolongation. Finally, a longer time period between correction and PVR was associated with an increased hazard of cardiac death (hazard ratio 1.097, 95% confidence interval 1.002–1.200). CONCLUSIONS Prolongation of QRS duration after PVR was associated with a longer time between correction and PVR, older age at correction and male sex. Prevention of progressive QRS prolongation by earlier PVR can potentially reduce the hazard of adverse events after PVR.
Collapse
Affiliation(s)
- Jamie L R Romeo
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Judith A A E Cuypers
- Department of Congenital Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Natasha M S de Groot
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Pieter van de Woestijne
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Nico Bruining
- Department of Clinical and Experimental Information Procession, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - M Mostafa Mokhles
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| |
Collapse
|
12
|
Thuraisingam A, Skillington P, Ludhani P, Wijayarathne PM, Menahem S, Larobina M, Grigg L, Wilson W. Long-term outcomes of right ventricle-to-pulmonary artery conduit insertion in adults with congenital heart disease: survival analysis by National Death Index. Eur J Cardiothorac Surg 2021; 60:939-946. [PMID: 33779724 DOI: 10.1093/ejcts/ezab148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/09/2021] [Accepted: 02/24/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the long-term outcomes following right ventricle-to-pulmonary artery (RV-to-PA) conduit insertion of Medtronic Freestyle® porcine valve (MFV) or pulmonary allograft valve (PAV) in adult patients with congenital heart disease. METHODS Retrospective medical record review of consecutive RV-to-PA conduit insertion, using either PAV or MFV from 1991 to 2017. Perioperative data and clinic reports were collected. Cause and date of death were obtained from the Australian National Death Index to obtain survival function. RESULTS In total, 232 patients (median age 31.5 years, interquartile range 25-41 years) underwent RV-to-PA conduit insertion (PAV = 84 and MFV = 148) and were eligible for inclusion [63.8% tetralogy of Fallot (TOF); 11.6% congenital pulmonary stenosis (PS); 24.6% other diagnoses]. The overall median follow-up time was 9.1 years (interquartile range 5.3-12.6 years). The mean gradient was 11.8 ± 7.1 mmHg in PAV and 16.6 ± 9.6 mmHg in MFV patients. Congenital PS patients had 100% survival at 20 years, TOF patients at 5, 10, 15 and 20 years had 99%, 97%, 96% and 96% survival, respectively. Patients with other primary diagnoses at 5, 10, 15 and 20 years had 93%, 91%, 87% and 87% respectively. Freedom from reintervention did not differ significantly at 5 and 10 years between pulmonary allograft (98.6%, 98.6%) and Freestyle® porcine bioprosthesis (97.5%, 93%). CONCLUSIONS Both valves perform equally well with regard to patients' freedom from reoperation, although transvalvular gradient was higher for Freestyle® patients. Congenital PS and TOF patients had better survival than patients with other primary diagnoses.
Collapse
Affiliation(s)
- Amalan Thuraisingam
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Peter Skillington
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Cardiothoracic Surgery, Melbourne Private Hospital, Parkville, VIC, Australia.,Department of Cardiothoracic Surgery, Epworth Hospital, Richmond, VIC, Australia
| | - Prakash Ludhani
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - Samuel Menahem
- Department of Cardiology, Epworth and Melbourne Private Hospital, Melbourne, VIC, Australia
| | - Marco Larobina
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Cardiothoracic Surgery, Melbourne Private Hospital, Parkville, VIC, Australia.,Department of Cardiothoracic Surgery, Epworth Hospital, Richmond, VIC, Australia
| | - Leeanne Grigg
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Will Wilson
- Department of Cardiology, Epworth and Melbourne Private Hospital, Melbourne, VIC, Australia
| |
Collapse
|
13
|
Meca Aguirrezabalaga JA, Silva Guisasola J, Díaz Méndez R, Escalera Veizaga AE, Hernández-Vaquero Panizo D. Pulmonary regurgitation after repaired tetralogy of Fallot: surgical versus percutaneous treatment. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:967. [PMID: 32953767 PMCID: PMC7475380 DOI: 10.21037/atm.2020.03.81] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pulmonary regurgitation is the most important sequellae after correction of Tetralogy of Fallot and has a considerable impact over the right ventricle. Surgery has demonstrated low early mortality after pulmonary valve replacement and good long-term outcomes, remaining nowadays the gold standard treatment of pulmonary regurgitation in rTOF patients. Nevertheless, transcatheter pulmonary valve implantation has emerged as a new, safe and efficient alternative to surgical valve replacement. In this review article, we try to evaluate and compare both techniques to find out which is the best therapeutic option in this patients.
Collapse
Affiliation(s)
| | - Jacobo Silva Guisasola
- Department of Cardiac Surgery, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Rocío Díaz Méndez
- Department of Cardiac Surgery, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | |
Collapse
|
14
|
Fujita H, Matsumoto K, Miwa K, Suzuki M, Suto M, Sakai J, Tanaka H, Hirata KI. "The Heart Sound Quintet": A Case Report of Right-Sided Heart Failure Due to Free Pulmonary Regurgitation Long After Intracardiac Repair of Tetralogy of Fallot. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e924636. [PMID: 32675802 PMCID: PMC7386553 DOI: 10.12659/ajcr.924636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patient: Male, 52-year-old Final Diagnosis: Tetralogy of Fallot (TOF) Symptoms: Palpitation Medication: — Clinical Procedure: Computed tomography • echocardiography • magnetic resonance imaging Specialty: Cardiology
Collapse
Affiliation(s)
- Hiroshi Fujita
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kensuke Matsumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Keisuke Miwa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Makiko Suzuki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Makiko Suto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Jun Sakai
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| |
Collapse
|
15
|
He F, Feng Z, Chen Q, Jiao Y, Hua Z, Zhang H, Yang K, Pang K, Lu M, Ma K, Zhang S, Qi L, Wang G, Li S. Whether Pulmonary Valve Replacement in Asymptomatic Patients With Moderate or Severe Regurgitation After Tetralogy of Fallot Repair Is Appropriate: A Case-Control Study. J Am Heart Assoc 2020; 8:e010689. [PMID: 30587056 PMCID: PMC6405720 DOI: 10.1161/jaha.118.010689] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background Although right ventricular (RV) volume was significantly decreased in symptomatic patients with repaired tetralogy of Fallot (rTOF) after pulmonary valve replacement (PVR), RV size was still enlarged along with RV dysfunction. Methods and Results A prospective case‐control study was conducted in a tertiary hospital; 81 asymptomatic repaired tetralogy of Fallot patients with moderate or severe pulmonary regurgitation were enrolled. The enrolled cohort was divided into 2 groups: PVR group (n=41) and medication group (n=40). Cardiac magnetic resonance, transthoracic echocardiography, and electrocardiography were scheduled after recruitment and 6 months after PVR or recruitment. Adverse events were recorded during follow‐up. Three deaths, 1 heart transplantation, 3 PVRs, and 2 symptomatic heart failures in medication group and 1 redo PVR in the PVR group were observed during follow‐up. Compared with the medication group, the PVR group had significantly lower adverse events rate (P=0.023; odds ratio, 0.086; 95% CI, 0.010–0.716), and RV function was significantly improved (P<0.05). Binary logistic regression analysis identified preoperative RV end‐systolic volume index (10‐mL/m2 increment, P=0.009; odds ratio, 0.64; 95% CI, 0.457–0.893) was an independent predictor of normalization of RV size after PVR. A preoperative RV end‐systolic volume index cut‐off value of 120 mL/m2 (area under curve, 0.819; sensitivity, 90.3%; specificity, 70%) was analyzed by receiver operating characteristic curves for normalized RV size after PVR. Conclusions PVR in asymptomatic repaired tetralogy of Fallot patients is appropriate and effective in reducing right ventricular size and preserving right ventricular function. The recommended criterion of RV end‐systolic volume index for PVR is 120 mL/m2.
Collapse
Affiliation(s)
- Fengpu He
- 1 Pediatric Cardiac Surgery Center National Center for Cardiovascular Disease and Fuwai Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing China
| | - Zicong Feng
- 1 Pediatric Cardiac Surgery Center National Center for Cardiovascular Disease and Fuwai Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing China
| | - Qiuming Chen
- 1 Pediatric Cardiac Surgery Center National Center for Cardiovascular Disease and Fuwai Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing China
| | - Yiping Jiao
- 2 Psychological Teaching and Research Department Hangzhou Armed Police Officer School Hangzhou China
| | - Zhongdong Hua
- 1 Pediatric Cardiac Surgery Center National Center for Cardiovascular Disease and Fuwai Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing China
| | - Hao Zhang
- 1 Pediatric Cardiac Surgery Center National Center for Cardiovascular Disease and Fuwai Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing China
| | - Keming Yang
- 1 Pediatric Cardiac Surgery Center National Center for Cardiovascular Disease and Fuwai Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing China
| | - Kunjing Pang
- 1 Pediatric Cardiac Surgery Center National Center for Cardiovascular Disease and Fuwai Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing China
| | - Minjie Lu
- 3 Department of Magnetic Resonance Imaging National Center for Cardiovascular Disease and Fuwai Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing China
| | - Kai Ma
- 1 Pediatric Cardiac Surgery Center National Center for Cardiovascular Disease and Fuwai Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing China
| | - Sen Zhang
- 1 Pediatric Cardiac Surgery Center National Center for Cardiovascular Disease and Fuwai Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing China
| | - Lei Qi
- 1 Pediatric Cardiac Surgery Center National Center for Cardiovascular Disease and Fuwai Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing China
| | - Guanxi Wang
- 1 Pediatric Cardiac Surgery Center National Center for Cardiovascular Disease and Fuwai Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing China
| | - Shoujun Li
- 1 Pediatric Cardiac Surgery Center National Center for Cardiovascular Disease and Fuwai Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing China
| |
Collapse
|
16
|
Kimura Y, Fukuda K, Nakano M, Hasebe Y, Fukasawa K, Chiba T, Miki K, Tatebe S, Miyata S, Ota H, Kimura M, Adachi O, Saiki Y, Shimokawa H. Prognostic Significance of PR Interval Prolongation in Adult Patients With Total Correction of Tetralogy of Fallot. Circ Arrhythm Electrophysiol 2018; 11:e006234. [PMID: 30571179 DOI: 10.1161/circep.118.006234] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Several studies have demonstrated the importance of mechanoelectrical interaction in patients with surgically corrected tetralogy of Fallot. However, the significance of atrioventricular conduction disturbance, that is PR interval prolongation, on adverse cardiac events in those patients remains to be elucidated. METHODS We examined electrocardiograms at baseline and their temporal change in a total of 176 patients with repaired tetralogy of Fallot (49% men; median age, 17.4 years). Then, we evaluated their correlation with right ventricular volume and function measured by cardiac magnetic resonance and the significance as a risk factor of adverse cardiac events: lethal ventricular arrhythmias, atrial arrhythmias, heart failure hospitalization, complete atrioventricular block (AVB), and all-cause death. RESULTS First-degree AVB was noted in 25 patients (14%). During a median follow-up of 10.0 (5.0-14.2) years, there was a progressive prolongation of PR interval (2.00±3.99 ms/y). Importantly, there were significant correlations between PR interval prolongation and right ventricular enlargement or right ventricular dysfunction. In contrast, in patients who underwent pulmonary valve replacement (n=23), significant shortening of PR interval by pulmonary valve replacement was noted (204±32 versus 176±34 ms; P=0.007). Cox regression analysis showed that first-degree AVB was an independent risk factor for lethal ventricular arrhythmias (hazard ratio, 5.479; 95% CI, 1.181-25.42; P=0.030) and complete AVB (hazard ratio, 27.67; 95% CI, 4.152-184.3; P<0.001) and had a tendency for heart failure hospitalization (hazard ratio, 3.301; 95% CI, 0.864-11.80; P=0.069). In addition, PR interval prolongation >2 ms/y was also a significant risk factor for lethal ventricular arrhythmias, regardless of the presence or absence of first-degree AVB at enrollment (hazard ratio, 24.18; 95% CI, 2.080-281.1; P=0.011). CONCLUSIONS These results indicate that progressive atrioventricular conduction disturbance is correlated with right ventricular enlargement and could be a useful predictor for increased risk of lethal ventricular arrhythmias in patients with repaired tetralogy of Fallot.
Collapse
Affiliation(s)
- Yoshitaka Kimura
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (Y.K., K. Fukuda, M.N., Y.H., K. Fukasawa, T.C., K.M., S.T., H.S.)
| | - Koji Fukuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (Y.K., K. Fukuda, M.N., Y.H., K. Fukasawa, T.C., K.M., S.T., H.S.)
| | - Makoto Nakano
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (Y.K., K. Fukuda, M.N., Y.H., K. Fukasawa, T.C., K.M., S.T., H.S.)
| | - Yuhi Hasebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (Y.K., K. Fukuda, M.N., Y.H., K. Fukasawa, T.C., K.M., S.T., H.S.)
| | - Kyoshiro Fukasawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (Y.K., K. Fukuda, M.N., Y.H., K. Fukasawa, T.C., K.M., S.T., H.S.)
| | - Takahiko Chiba
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (Y.K., K. Fukuda, M.N., Y.H., K. Fukasawa, T.C., K.M., S.T., H.S.)
| | - Keita Miki
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (Y.K., K. Fukuda, M.N., Y.H., K. Fukasawa, T.C., K.M., S.T., H.S.)
| | - Shunsuke Tatebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (Y.K., K. Fukuda, M.N., Y.H., K. Fukasawa, T.C., K.M., S.T., H.S.)
| | - Satoshi Miyata
- Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (S.M., H.S.)
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan (H.O.)
| | - Masato Kimura
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan (M.K.)
| | - Osamu Adachi
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan (O.A., Y.S.)
| | - Yoshikatsu Saiki
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan (O.A., Y.S.)
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (Y.K., K. Fukuda, M.N., Y.H., K. Fukasawa, T.C., K.M., S.T., H.S.).,Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (S.M., H.S.)
| |
Collapse
|
17
|
Dłużniewska N, Podolec P, Skubera M, Smaś-Suska M, Pająk J, Urbańczyk-Zawadzka M, Płazak W, Olszowska M, Tomkiewicz-Pająk L. Long-term follow-up in adults after tetralogy of Fallot repair. Cardiovasc Ultrasound 2018; 16:28. [PMID: 30373624 PMCID: PMC6206664 DOI: 10.1186/s12947-018-0146-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 10/08/2018] [Indexed: 11/29/2022] Open
Abstract
Background Tetralogy of Fallot (ToF) is the most common cyanotic congenital heart disease and the population of ToF repair survivors is growing rapidly. Adults with repaired ToF develop late complications. The aim of this study was to describe and analyze long-term follow-up of patients with repaired ToF. Methods This is a retrospective cohort study. Consecutive 83 patients with repaired ToF who did not undergo pulmonary valve replacement were included. Mean age of all patients was 30.5 ± 10.7. There were 49 (59%) male. Patients were divided into two groups according to the time since the repair (< 25 years and ≥ 25 years). The electrocardiographic (ECG), cardiopulmonary exercise testing (CPET), echocardiographic and cardiac magnetic resonance (CMR) data were reviewed retrospectively. Results In CPET values were not significantly different in the two groups. In CMR volumes of left and right ventricles were not significantly different in the two groups. There were no differences between the groups in ventricular ejection fraction, mass of ventricles, or pulmonary regurgitation fraction. Among all the patients, ejection fraction and left and right ventricle mass, indexed pulmonary regurgitation volume measured by CMR did not correlate with the time since repair. In ECG among all the patients, ejection fraction of the RV, measured in CMR, negatively correlated with QRS duration (r = − 0.43; p < 0.001). There was a positive correlation between QRS duration and end diastolic volume of the RV (r = 0.30; p < 0.02), indexed end diastolic volume of the RV (r = 0.29; p = 0.04), RV mass (r = 0.36; p < 0.001) and left ventricle mass (r = 0.26; p = 0.04). Conclusion Long-term survival and clinical condition after surgical correction of ToF in infancy is generally good and the late functional status in ToF – operated patients could be excellent up to 25 years after the repair. QRS duration could be an utility and easy factor to assessment of right ventricular function. Trial registration The study protocol was approved by the local Ethics Committee. Each participant provided informed consent to participate in the study (license number 122.6120.88.2016 from 28.04.2016).
Collapse
Affiliation(s)
- Natalia Dłużniewska
- Department of Cardiac and Vascular Disease, Collegium Medicum, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Piotr Podolec
- Department of Cardiac and Vascular Disease, Collegium Medicum, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Maciej Skubera
- Department of Cardiac and Vascular Disease, Collegium Medicum, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Monika Smaś-Suska
- Department of Cardiac and Vascular Disease, Collegium Medicum, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Jacek Pająk
- Paediatric Heart Surgery Department and General Paediatric Surgery Department, Medical University of Warsaw, Warsaw, Poland
| | | | - Wojciech Płazak
- Department of Cardiac and Vascular Disease, Collegium Medicum, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Maria Olszowska
- Department of Cardiac and Vascular Disease, Collegium Medicum, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Lidia Tomkiewicz-Pająk
- Department of Cardiac and Vascular Disease, Collegium Medicum, Jagiellonian University, John Paul II Hospital, Krakow, Poland.
| |
Collapse
|
18
|
Yun Y, Kim YH, Kwon JE. The change of QRS duration after pulmonary valve replacement in patients with repaired tetralogy of Fallot and pulmonary regurgitation. KOREAN JOURNAL OF PEDIATRICS 2018; 61:362-365. [PMID: 30360038 PMCID: PMC6258967 DOI: 10.3345/kjp.2018.06765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/24/2018] [Indexed: 11/27/2022]
Abstract
Purpose This study aimed to analyze changes in QRS duration and cardiothoracic ratio (CTR) following pulmonary valve replacement (PVR) in patients with tetralogy of Fallot (TOF). Methods Children and adolescents who had previously undergone total repair for TOF (n=67; median age, 16 years) who required elective PVR for pulmonary regurgitation and/or right ventricular out tract obstruction were included in this study. The QRS duration and CTR were measured pre- and postoperatively and postoperative changes were evaluated. Results Following PVR, the CTR significantly decreased (pre-PVR 57.2%±6.2%, post-PVR 53.8%±5.5%, P=0.002). The postoperative QRS duration showed a tendency to decrease (pre-PVR 162.7±26.4 msec, post-PVR 156.4±24.4 msec, P=0.124). QRS duration was greater than 180 msec in 6 patients prior to PVR. Of these, 5 patients showed a decrease in QRS duration following PVR; QRS duration was less than 180 msec in 2 patients, and QRS duration remained greater than 180 msec in 3 patients, including 2 patients with diffuse postoperative right ventricular outflow tract hypokinesis. Six patients had coexisting arrhythmias before PVR; 2 patients, atrial tachycardia; 3 patients, premature ventricular contraction; and 1 patient, premature atrial contraction. None of the patients presented with arrhythmia following PVR. Conclusion The CTR and QRS duration reduced following PVR. However, QRS duration may not decrease below 180 msec after PVR, particularly in patients with right ventricular outflow tract hypokinesis. The CTR and ECG may provide additional clinical information on changes in right ventricular volume and/or pressure in these patients.
Collapse
Affiliation(s)
- Yuni Yun
- Division of Pediatric Cardiology, Department of Pediatrics, Kyungpook National University Children's Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yeo Hyang Kim
- Division of Pediatric Cardiology, Department of Pediatrics, Kyungpook National University Children's Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jung Eun Kwon
- Division of Pediatric Cardiology, Department of Pediatrics, Kyungpook National University Children's Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| |
Collapse
|
19
|
de Torres-Alba F, Kaleschke G, Baumgartner H. Impacto del implante percutáneo de válvula pulmonar en cuanto al momento de reintervenir por disfunción del tracto de salida del ventrículo derecho. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2018.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
20
|
de Torres-Alba F, Kaleschke G, Baumgartner H. Impact of Percutaneous Pulmonary Valve Implantation on the Timing of Reintervention for Right Ventricular Outflow Tract Dysfunction. ACTA ACUST UNITED AC 2018; 71:838-846. [PMID: 29859895 DOI: 10.1016/j.rec.2018.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 04/23/2018] [Indexed: 02/07/2023]
Abstract
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart defect. Early surgical repair has dramatically improved the outcome of this condition. However, despite the success of contemporary approaches with early complete repair, these are far from being curative and late complications are frequent. The most common complication is right ventricle outflow tract (RVOT) dysfunction, affecting most patients in the form of pulmonary regurgitation, pulmonary stenosis, or both, and can lead to development of symptoms of exercise intolerance, arrhythmias, and sudden cardiac death. Optimal timing of restoration of RVOT functionality in asymptomatic patients with RVOT dysfunction after TOF repair is still a matter of debate. Percutaneous pulmonary valve implantation, introduced almost 2 decades ago, has become a major game-changer in the treatment of RVOT dysfunction. In this article we review the pathophysiology, the current indications, and treatment options for RVOT dysfunction in patients after TOF repair with a focus on the role of percutaneous pulmonary valve implantation in the therapeutic approach to these patients.
Collapse
Affiliation(s)
- Fernando de Torres-Alba
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany.
| | - Gerrit Kaleschke
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany
| | - Helmut Baumgartner
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany
| |
Collapse
|
21
|
Matsuo K, Kabasawa M, Asano S, Tateno S, Kawasoe Y, Okajima Y, Hayashida N, Murayama H. Surgical treatment for adult congenital heart disease: consideration for indications and procedures. Gen Thorac Cardiovasc Surg 2017; 66:57-64. [PMID: 29119450 DOI: 10.1007/s11748-017-0861-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 10/28/2017] [Indexed: 11/29/2022]
Abstract
The number of the adult patients with congenital heart diseases (ACHD) continues to grow owing to improvement of surgical results and medical management. Corrective surgery for complex CHD does not always mean complete cure. It is not rare that the patients will visit the cardiology institutes because of secondary lesions due to residua or sequela in adults. Some patients with CHD remain unrepairable with different degree of heart failure and pulmonary arterial hypertension. Association of arrhythmias is common in ACHD patients and sometimes critical. We experienced 265 surgical procedures for ACHD patients at our center between 1999 and 2015. Of these procedures, palliative surgery was performed in 3%, palliation to corrective surgery in 6%, primary repair in 57%, and redo surgery in 34%. Hospital mortality within 30 days in this period was 1.1%. Surgery for ACHD patients is safe, beneficial and low-risk treatment; however, tailored procedures for the individual patient are essential to obtain the optimal quality. A comprehensive multidisciplinary approach is required to fulfill this goal.
Collapse
Affiliation(s)
- Kozo Matsuo
- Department of Cardiovascular Surgery, Chiba Cerebral and Cardiovascular Center, 575 Tsurumai, Ichihara, Chiba, 290-0512, Japan.
| | - Masashi Kabasawa
- Department of Cardiovascular Surgery, Chiba Cerebral and Cardiovascular Center, 575 Tsurumai, Ichihara, Chiba, 290-0512, Japan
| | - Soichi Asano
- Department of Cardiovascular Surgery, Chiba Cerebral and Cardiovascular Center, 575 Tsurumai, Ichihara, Chiba, 290-0512, Japan
| | - Shigeru Tateno
- Section of Adult Congenital Heart Disease, Chiba Cerebral and Cardiovascular Center, 575 Tsurumai, Ichihara, Chiba, 290-0512, Japan
| | - Yasutaka Kawasoe
- Section of Adult Congenital Heart Disease, Chiba Cerebral and Cardiovascular Center, 575 Tsurumai, Ichihara, Chiba, 290-0512, Japan
| | - Yoshitomo Okajima
- Section of Adult Congenital Heart Disease, Chiba Cerebral and Cardiovascular Center, 575 Tsurumai, Ichihara, Chiba, 290-0512, Japan
| | - Naoki Hayashida
- Department of Cardiovascular Surgery, Chiba Cerebral and Cardiovascular Center, 575 Tsurumai, Ichihara, Chiba, 290-0512, Japan
| | - Hirokazu Murayama
- Department of Cardiovascular Surgery, Chiba Cerebral and Cardiovascular Center, 575 Tsurumai, Ichihara, Chiba, 290-0512, Japan
| |
Collapse
|
22
|
Koyak Z, de Groot JR, Bouma BJ, Zwinderman AH, Silversides CK, Oechslin EN, Budts W, Van Gelder IC, Mulder BJM, Harris L. Sudden cardiac death in adult congenital heart disease: can the unpredictable be foreseen? Europace 2017; 19:401-406. [PMID: 27247006 DOI: 10.1093/europace/euw060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 02/20/2016] [Indexed: 11/12/2022] Open
Abstract
Aims Sudden cardiac death (SCD) is a major cause of mortality in adults with congenital heart disease (CHD). Several risk factors for SCD including conduction disturbances and ventricular dysfunction have been described previously. However, electrocardiogram (ECG) and echocardiographic parameters may change over time, and the predictive value of such temporal changes, rather than their point estimates, for SCD remains unknown. Methods and results This was a retrospective case-control study in adults with CHD and proven or presumed SCD and matched controls. Data were obtained from three databases including 25 000 adults with CHD. Sequential measurements were performed on electrocardiograms and echocardiograms. Ventricular function was assessed by echocardiography and graded on a four-point ordinal scale: 1, normal [ejection fraction (EF) ≥50%]; 2, mildly impaired (EF 40-49%); 3, moderately impaired (EF 30-39%); and 4, severely impaired (EF < 30%). Overall, 131 SCDs (mean age 36 ± 14 years, 67% male) and 260 controls (mean age 37 ± 13 years, 63% male) were included. At baseline, median QRS duration was 108 ms (range 58-168 ms) in SCDs and 97 ms (range 50-168 ms) in controls and increased over time at a rate of 1.6 ± 0.5 vs. 0.5 ± 0.2 ms/year in SCDs and controls, respectively (P = 0.011). QT dispersion at baseline was 61 ms (range 31-168 ms) in SCDs and 50 ms (range 21-129 ms) in controls. QT dispersion increased at a rate of 1.1 ± 0.4 ms/year in SCD victims and decreased at a rate of 0.2 ± 0.2 ms/year in controls (P = 0.004). Increase of QRS duration ≥5 ms/year was associated with an increased risk of SCD [OR 1.9, 95% confidence interval (CI) 1.1-3.3, P = 0.013]. Change from any baseline systemic ventricular function (normal, mild, or moderately impaired) to severe ventricular dysfunction over time was associated with the highest risk of SCD (OR 16.9, 95% CI 1.8-120.1, P = 0.008). Conclusion In adults with CHD, QRS duration and ventricular dysfunction progress over time. Progression of QRS duration and the rate of impairment of ventricular function served to identify those at increased risk of SCD.
Collapse
Affiliation(s)
- Zeliha Koyak
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.,Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
| | - Joris R de Groot
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Berto J Bouma
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
| | - Candice K Silversides
- Department of Cardiology, Peter Munk Cardiac Center, Toronto Congenital Cardiac Center for Adults, and University of Toronto, Toronto, Canada
| | - Erwin N Oechslin
- Department of Cardiology, Peter Munk Cardiac Center, Toronto Congenital Cardiac Center for Adults, and University of Toronto, Toronto, Canada
| | - Werner Budts
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Isabelle C Van Gelder
- Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara J M Mulder
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.,Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
| | - Louise Harris
- Department of Cardiology, Peter Munk Cardiac Center, Toronto Congenital Cardiac Center for Adults, and University of Toronto, Toronto, Canada
| |
Collapse
|
23
|
Li HF, Wu Y, Wang M, Grunkemeier GL. A Stopping Guideline for Pulmonary Heart Valve Premarket Approval Studies. Semin Thorac Cardiovasc Surg 2017; 30:81-84. [PMID: 28987280 DOI: 10.1053/j.semtcvs.2017.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Hsin-Fang Li
- Medical Data Research Center, Providence Health and Service, Portland, Oregon.
| | - YingXing Wu
- Medical Data Research Center, Providence Health and Service, Portland, Oregon
| | - Mansen Wang
- Medical Data Research Center, Providence Health and Service, Portland, Oregon
| | - Gary L Grunkemeier
- Medical Data Research Center, Providence Health and Service, Portland, Oregon
| |
Collapse
|
24
|
Pilato R, Lacroix D, Domanski O, Godart F. [Pulmonary revalvulation and rhythmologenic risks in patients with repaired tetralogy of Fallot]. Presse Med 2017; 46:586-593. [PMID: 28583744 DOI: 10.1016/j.lpm.2017.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/12/2016] [Accepted: 02/16/2017] [Indexed: 10/19/2022] Open
Abstract
Tetralogy of Fallot is a frequent congenital heart disease that has been repaired since the mid-1950s. The follow-up after repair is good despite a persistent risk of sudden death. The risk factors in long-term follow-up are advanced age at repair, hemodynamic status of the right ventricle, QRS duration≥180ms, left ventricular dysfunction, and existence of sustained or not ventricular tachycardia. In the presence of significant pulmonary regurgitation, it is necessary to perform revalvulation either by classic surgery or cardiac catheterization. To correct the risk of ventricular arrhythmia, some have proposed radiofrequency ablation of critical isthmus, or cryo-application during surgery. However, the use of implantable cardioverter defibrillator is another therapeutic option that is more and more employed as secondary or primary prevention in patients at risk of sudden death.
Collapse
Affiliation(s)
- Rosario Pilato
- CHRU de Lille, hôpital cardiologique, service des maladies cardiovasculaires infantiles et congénitales, boulevard Pr.-Leclercq, 59037 Lille cedex, France
| | - Dominique Lacroix
- University Lille, faculté de médicine, 59000 Lille, France; CHRU de Lille, hôpital cardiologique, service de cardiologie, boulevard Pr.-Leclercq, 59037 Lille cedex, France
| | | | - François Godart
- University Lille, faculté de médicine, 59000 Lille, France; CHRU de Lille, hôpital cardiologique, service de cardiologie, boulevard Pr.-Leclercq, 59037 Lille cedex, France.
| |
Collapse
|
25
|
Shin HJ, Song S, Shin YR, Park HK, Park YH. Concomitant Right Ventricular Outflow Tract Cryoablation during Pulmonary Valve Replacement in a Patient with Tetralogy of Fallot. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 50:41-43. [PMID: 28180102 PMCID: PMC5295482 DOI: 10.5090/kjtcs.2017.50.1.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/15/2016] [Accepted: 07/02/2016] [Indexed: 11/16/2022]
Abstract
A 38-year-old female patient with a history of tetralogy of Fallot repair at 10 years of age underwent pulmonary valve replacement with a mechanical prosthesis, tricuspid annuloplasty, and right ventricular outflow tract cryoablation due to pulmonary regurgitation, tricuspid regurgitation, and multiple premature ventricular contractions with sustained ventricular tachycardia. After surgery, she had an uneventful postoperative course with arrhythmia monitoring. She was discharged without incident, and a follow-up Holter examination showed a decrease in the number of ventricular ectopic beats from 702 to 41.
Collapse
Affiliation(s)
- Hong Ju Shin
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine; Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine
| | - Seunghwan Song
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Yu Rim Shin
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Han Ki Park
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Young Hwan Park
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| |
Collapse
|
26
|
Pietrzak R, Werner B. Postsystolic Shortening Is Associated with Altered Right Ventricular Function in Children after Tetralogy of Fallot Surgical Repair. PLoS One 2017; 12:e0169178. [PMID: 28046050 PMCID: PMC5207703 DOI: 10.1371/journal.pone.0169178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 12/13/2016] [Indexed: 12/02/2022] Open
Abstract
The aim of the study was to determine whether segmental interactions, as expressed by postsystolic shortening (PSS), affects RV mechanics and are connected with impaired systolic and diastolic function in rTOF children. Patients and Methods: 55 rTOF adolescent (study group), and 34 healthy volunteers (control group) were examined using classical Doppler flow (Doppler), Tissue Doppler Imaging (TDI) and Speckle Tracking Echocardiography (STE). PSS was found to occur when time to peak (TTP) was longer than pulmonary valve closure time (PVCT). TTP and strain were derived from RV lateral segments—basal (BL), medial (ML) and apical (AL) in STE. PVCT was measured from the beginning of QRS complex in the ECG to the termination of Doppler flow at the pulmonary valve. TDI was obtained at the lateral tricuspid annulus site and the systolic (S′), early (E′) and late diastolic (A’) peak velocities were measured along with isovolumic contraction (IVCT), and relaxation (IVRT) time. PW was used to measure early tricuspid inflow velocity (E) for calculating the E/E’ ratio. The TDI data in patients with PSS presence (TTP>PVCT) and those in whom it did not occur (TTP≤PVCT) were compared. Results: PSS in BL, ML and AL were observed respectively in: 27(51,9%), 9 (18%), and 8 (16,7%) patients. Mean values of TTP in BL, ML, and AL were respectively: 420.6±55.5ms, 389.8±50.0ms and 366.7±59.0ms. PVCT mean value was 396.6±33.5ms. In the study group, the mean E’ in TTP>PVCT was significantly lower (4.8±1.8 cm/s) compared to mean E’ in TTP≤PVCT (8.4±2.6 cm/s), p<0.01. The average E/E’ was significantly higher in TTP>PCVT than in TTP≤PVCT, respectively 21.6±7.3 vs 12.2±5.1, p<0.05. IVRT was significantly prolonged in TTP>PVCT compared to IVRT in TTP≤PVCT, respectively 95.9±38.7 vs 77.0±35.1, p<0.05. Furthermore, in TTP>PVCT, significantly higher strain in BL (-28.8±8.7%) was observed when compared to that parameter in TTP≤PVCT (-35.3±13.1%), p <0.05. Conclusions: Tissue Doppler Echocardiography and Speckle Tracking Echocardiography are useful techniques for detecting regional systolic and diastolic dysfunction in children after Tetralogy of Fallot surgical repair. Postsystolic shortening in the basal lateral segment is commonly seen in children after the Tetralogy of Fallot surgical repair, and is associated with altered right ventricular systolic and diastolic function.
Collapse
Affiliation(s)
- Radosław Pietrzak
- Department of Pediatric Cardiology and General Pediatrics. Medical University of Warsaw Zwirki i Wigury, Warsaw, Poland
| | - Bożena Werner
- Department of Pediatric Cardiology and General Pediatrics. Medical University of Warsaw Zwirki i Wigury, Warsaw, Poland
- * E-mail:
| |
Collapse
|
27
|
Kim YY, Ruckdeschel E. Approach to residual pulmonary valve dysfunction in adults with repaired tetralogy of Fallot. Heart 2016; 102:1520-6. [DOI: 10.1136/heartjnl-2015-309067] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 05/23/2016] [Indexed: 12/28/2022] Open
|
28
|
Timing of Pulmonary Valve Replacement: How Much Can the Right Ventricle Dilate Before it Looses Its Remodeling Potential? Pediatr Cardiol 2016; 37:601-5. [PMID: 26687177 DOI: 10.1007/s00246-015-1320-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 12/07/2015] [Indexed: 01/28/2023]
Abstract
Congenital heart disease patients that develop secondary pulmonary regurgitation require a pulmonary valve replacement (PVR) in their follow-up. The indications for PVR in asymptomatic patients are debated. Most guidelines consider a RV end-diastolic volume (RVEDV) over 150 ml/m(2) as an indication for PVR. We analyzed clinical, echocardiographic and MRI variables of patients that underwent a surgical PVR between September 2006 and February 2013. The included patients were asymptomatic, without pulmonary stenosis and with both pre- and post-surgery MRI. Thirty-five patients (74.3 % males) were included. Mean age at PVR was 25.8 years (SD = 7.18), and weight was 64.5 Kg (SD = 12.03). The main diagnosis was tetralogy of Fallot (n = 28), pulmonary atresia (n = 2), primary pulmonary regurgitation (n = 2) and pulmonary regurgitation after percutaneous treatment (n = 2). The maximal RVEDV pre-PVR was 267 ml/m(2), and right ventricular end-systolic volume (RVESV) was 183 ml/m(2). RV size and function were established by MRI: Pre-PVR Post-PVR p RVEDV (ml/m(2)) 162 (SD = 39.1) 94 (SD = 23.6) <0.001 RVESV (ml/m(2)) 87 (SD = 28.9) 44 (SD = 15.7) <0.001 RVEF 44.8 % (SD = 8.17) 52 % (SD = 9.9) <0.001 Patients with a RVEDV under 170 ml/m(2) combined with a RVESV under 90 ml/m(2) had a favorable RV remodeling, defined as RVEDV under 110 ml/m(2) (sensitivity 87.5 %), RVESV under 55 ml/m(2) (sensitivity 100 %) and RVEF over 50 % (sensitivity 100 %). When deciding the optimal PVR timing in asymptomatic patients, both RVEDV and RVESV should be considered. Our results suggest that higher volumes than used in the clinical practice can achieve a good remodeling. Therefore, PVR could be performed later in the follow-up reducing the number of cardiac interventions.
Collapse
|
29
|
Pulmonary valve replacement after repair of tetralogy of Fallot: Evolving strategies. J Thorac Cardiovasc Surg 2016; 151:623-625. [DOI: 10.1016/j.jtcvs.2015.09.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/02/2015] [Indexed: 02/03/2023]
|
30
|
Stout KK, Broberg CS, Book WM, Cecchin F, Chen JM, Dimopoulos K, Everitt MD, Gatzoulis M, Harris L, Hsu DT, Kuvin JT, Law Y, Martin CM, Murphy AM, Ross HJ, Singh G, Spray TL. Chronic Heart Failure in Congenital Heart Disease. Circulation 2016; 133:770-801. [DOI: 10.1161/cir.0000000000000352] [Citation(s) in RCA: 219] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
31
|
Müller J, Hager A, Diller GP, Derrick G, Buys R, Dubowy KO, Takken T, Orwat S, Inuzuka R, Vanhees L, Gatzoulis M, Giardini A. Peak oxygen uptake, ventilatory efficiency and QRS-duration predict event free survival in patients late after surgical repair of tetralogy of Fallot. Int J Cardiol 2015; 196:158-64. [DOI: 10.1016/j.ijcard.2015.05.174] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 05/29/2015] [Accepted: 05/30/2015] [Indexed: 12/16/2022]
|
32
|
Skoglund K, Eriksson P, Svensson G, Dellborg M. Homograft reconstruction of the right ventricular outflow tract in adults with congenital heart disease: a systematic review. Interact Cardiovasc Thorac Surg 2015; 22:57-62. [DOI: 10.1093/icvts/ivv264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/20/2015] [Indexed: 11/14/2022] Open
|
33
|
Riveros R, Riveros-Perez E. Perioperative Considerations for Children With Right Ventricular Dysfunction and Failing Fontan. Semin Cardiothorac Vasc Anesth 2015; 19:187-202. [PMID: 26287019 DOI: 10.1177/1089253215593178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The survival of patients with congenital heart diseases (CHD) has increased in the past decades, resulting in the identification of new characteristics of chronic comorbidities observed in pediatric and adults with CHD. Patients with CHD can present with a broad clinical spectrum of manifestations of congestive heart failure (CHF) at any point throughout their lives that may be related to anatomical or surgical variables. This article focuses on the perioperative assessment of patients with CHD and CHF, with an emphasis on pathophysiologic, diagnostic, and therapeutic alternatives in patients with right ventricular failure and failing Fontan circulation. We also provide descriptions of the effects of sedatives and anesthetics commonly used in this population in diagnostic or invasive procedures.
Collapse
|
34
|
Abstract
Patients with congenital heart disease and pulmonary valve disease need multiple procedures over their lifetimes to replace their pulmonary valves. Chronic pulmonary stenosis, regurgitation, or both have untoward effects on ventricular function and on the clinical status of these patients. To date, all right ventricle-pulmonary artery conduits have had relatively short lifespans. Percutaneous pulmonary valve implantation, although relatively new, will probably reduce the number of operative procedures that these patients will have to undergo over a lifetime. Refinement and further development of this procedure holds promise for the extension of this technology to other patient populations.
Collapse
|
35
|
Renapurkar RD, El-Sherief AH, Prieto L, Kapadia SR, Schoenhagen P. Transcatheter Structural Cardiac Intervention: A Radiology Perspective. AJR Am J Roentgenol 2015; 204:W648-W662. [DOI: 10.2214/ajr.14.12571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- Rahul D. Renapurkar
- Section of Thoracic Imaging, L10, Imaging Institute, Cleveland Clinic, Cleveland, OH 44195
- Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Ahmed H. El-Sherief
- Section of Thoracic Imaging, L10, Imaging Institute, Cleveland Clinic, Cleveland, OH 44195
| | - Lourdes Prieto
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | | | - Paul Schoenhagen
- Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland Clinic, Cleveland, OH
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| |
Collapse
|
36
|
Bokma JP, Winter MM, Oosterhof T, Vliegen HW, van Dijk AP, Hazekamp MG, Koolbergen DR, Groenink M, Mulder BJM, Bouma BJ. Severe tricuspid regurgitation is predictive for adverse events in tetralogy of Fallot. Heart 2015; 101:794-9. [DOI: 10.1136/heartjnl-2014-306919] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 03/11/2015] [Indexed: 11/03/2022] Open
|
37
|
Hallbergson A, Gauvreau K, Powell AJ, Geva T. Right Ventricular Remodeling After Pulmonary Valve Replacement: Early Gains, Late Losses. Ann Thorac Surg 2015; 99:660-6. [DOI: 10.1016/j.athoracsur.2014.09.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 09/01/2014] [Accepted: 09/09/2014] [Indexed: 12/19/2022]
|
38
|
Sabate Rotes A, Connolly HM, Warnes CA, Ammash NM, Phillips SD, Dearani JA, Schaff HV, Burkhart HM, Hodge DO, Asirvatham SJ, McLeod CJ. Ventricular arrhythmia risk stratification in patients with tetralogy of Fallot at the time of pulmonary valve replacement. Circ Arrhythm Electrophysiol 2014; 8:110-6. [PMID: 25416756 DOI: 10.1161/circep.114.001975] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Most patients with repaired tetralogy of Fallot require pulmonary valve replacement (PVR), but the evaluation for and management of ventricular arrhythmia remain unclear. This study is aimed at clarifying the optimal approach to this potentially life-threatening issue at the time of PVR. METHODS AND RESULTS A retrospective analysis was performed on 205 patients with repaired tetralogy of Fallot undergoing PVR at our institution between 1988 and 2010. Median age was 32.9 (range, 25.6) years. Previous ventricular tachycardia occurred in 16 patients (8%) and 37 (16%) had left ventricular dysfunction, defined as left ventricular ejection fraction <50%. Surgical right ventricular outflow tract cryoablation was performed in 22 patients (10.7%). The primary outcome was a combined event including ventricular tachycardia, out-of-hospital cardiac arrest, appropriate implantable cardioverter defibrillator therapy, and sudden cardiac death. Freedom from the combined event at 5, 10, and 15 years was 95%, 90%, and 79%, respectively. In the first year after PVR, 2 events occurred. Conversely, in the 22 patients who underwent surgical cryoablation, a single event occurred 7 years after PVR. A history of ventricular tachycardia and left ventricular dysfunction was associated with higher risk for the combined event (hazard ratio, 4.7; P=0.004 and hazard ratio, 0.8; P=0.02, respectively). CONCLUSIONS Patients with repaired tetralogy of Fallot undergoing PVR with history of ventricular tachycardia or left ventricular dysfunction appear to be associated with a higher risk of arrhythmic events after operation. Events in the first year after PVR are rare, and in select high-risk patients, surgical cryoablation does not seem to increase arrhythmic events and may be protective.
Collapse
Affiliation(s)
- Anna Sabate Rotes
- From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.)
| | - Heidi M Connolly
- From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.)
| | - Carole A Warnes
- From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.)
| | - Naser M Ammash
- From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.)
| | - Sabrina D Phillips
- From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.)
| | - Joseph A Dearani
- From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.)
| | - Hartzell V Schaff
- From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.)
| | - Harold M Burkhart
- From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.)
| | - David O Hodge
- From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.)
| | - Samuel J Asirvatham
- From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.)
| | - Christopher J McLeod
- From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.).
| |
Collapse
|
39
|
Udink ten Cate FE, Sreeram N, Brockmeier K. The pathophysiologic aspects and clinical implications of electrocardiographic parameters of ventricular conduction delay in repaired tetralogy of Fallot. J Electrocardiol 2014; 47:618-24. [DOI: 10.1016/j.jelectrocard.2014.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Indexed: 11/25/2022]
|
40
|
Hui W, Slorach C, Dragulescu A, Mertens L, Bijnens B, Friedberg MK. Mechanisms of Right Ventricular Electromechanical Dyssynchrony and Mechanical Inefficiency in Children After Repair of Tetralogy of Fallot. Circ Cardiovasc Imaging 2014; 7:610-8. [DOI: 10.1161/circimaging.113.001483] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Wei Hui
- From the Division of Pediatric Cardiology, The Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada (W.H., C.S., A.D., L.M., M.K.F.); and ICREA-Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain (B.B.)
| | - Cameron Slorach
- From the Division of Pediatric Cardiology, The Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada (W.H., C.S., A.D., L.M., M.K.F.); and ICREA-Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain (B.B.)
| | - Andreea Dragulescu
- From the Division of Pediatric Cardiology, The Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada (W.H., C.S., A.D., L.M., M.K.F.); and ICREA-Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain (B.B.)
| | - Luc Mertens
- From the Division of Pediatric Cardiology, The Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada (W.H., C.S., A.D., L.M., M.K.F.); and ICREA-Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain (B.B.)
| | - Bart Bijnens
- From the Division of Pediatric Cardiology, The Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada (W.H., C.S., A.D., L.M., M.K.F.); and ICREA-Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain (B.B.)
| | - Mark K. Friedberg
- From the Division of Pediatric Cardiology, The Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada (W.H., C.S., A.D., L.M., M.K.F.); and ICREA-Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain (B.B.)
| |
Collapse
|
41
|
Babu-Narayan SV, Diller GP, Gheta RR, Bastin AJ, Karonis T, Li W, Pennell DJ, Uemura H, Sethia B, Gatzoulis MA, Shore DF. Clinical Outcomes of Surgical Pulmonary Valve Replacement After Repair of Tetralogy of Fallot and Potential Prognostic Value of Preoperative Cardiopulmonary Exercise Testing. Circulation 2014; 129:18-27. [DOI: 10.1161/circulationaha.113.001485] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Indications for surgical pulmonary valve replacement (PVR) after repair of tetralogy of Fallot have recently been broadened to include asymptomatic patients.
Methods and Results—
The outcomes of PVR in adults after repair of tetralogy of Fallot at a single tertiary center were retrospectively studied. Preoperative cardiopulmonary exercise testing was included. Mortality was the primary outcome measure. In total, 221 PVRs were performed in 220 patients (130 male patients; median age, 32 years; range, 16–64 years). Homografts were used in 117 patients, xenografts in 103 patients, and a mechanical valve in 1 patient. Early (30-day) mortality was 2%. Overall survival was 97% at 1 year, 96% at 3 years, and 92% at 10 years. Survival after PVR in the later era (2005–2010; n=156) was significantly better compared with survival in the earlier era (1993–2004; n=65; 99% versus 94% at 1 year and 98% versus 92% at 3 years, respectively;
P
=0.019). Earlier era patients were more symptomatic preoperatively (
P
=0.036) with a lower preoperative peak oxygen consumption (peak
o
2
;
P
<0.001). Freedom from redo surgical or transcatheter PVR was 98% at 5 years and 96% at 10 years for the whole cohort. Peak
o
2
, E/CO2 slope (ratio of minute ventilation to carbon dioxide production), and heart rate reserve during cardiopulmonary exercise testing predicted risk of early mortality when analyzed with logistic regression analysis; peak
o
2
emerged as the strongest predictor on multivariable analysis (odds ratio, 0.65 per 1 mL·kg
−1
·min
−1
;
P
=0.041).
Conclusions—
PVR after repair of tetralogy of Fallot has a low and improving mortality, with a low need for reintervention. Preoperative cardiopulmonary exercise testing predicts surgical outcome and should therefore be included in the routine assessment of these patients.
Collapse
Affiliation(s)
- Sonya V. Babu-Narayan
- From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.)
| | - Gerhard-Paul Diller
- From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.)
| | - Radu R. Gheta
- From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.)
| | - Anthony J. Bastin
- From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.)
| | - Theodoros Karonis
- From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.)
| | - Wei Li
- From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.)
| | - Dudley J. Pennell
- From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.)
| | - Hideki Uemura
- From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.)
| | - Babulal Sethia
- From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.)
| | - Michael A. Gatzoulis
- From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.)
| | - Darryl F. Shore
- From the Royal Brompton and Harefield NHS Foundation Trust, London, UK (S.V.B.-N., G.-P.D., R.R.G., A.J.B., T.K., W.L., D.J.P., H.U., B.S., M.A.G., D.F.S.); and National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, UK (S.V.B.-N., W.L., D.J.P., M.A.G., D.F.S.)
| |
Collapse
|
42
|
|
43
|
Abstract
Pulmonary valve replacement is being performed with increasing frequency in patients with various congenital heart diseases. Chronic pulmonary regurgitation after repair of tetralogy of Fallot is a typical situation that requires pulmonary valve replacement. Chronic pulmonary regurgitation after repair of tetralogy of Fallot can lead to right ventricular dilatation, biventricular dysfunction, heart failure symptoms, arrhythmias, and sudden death. Although pulmonary valve replacement can lead to improvement in functional class and a substantial decrease or normalisation of right ventricular volumes, the optimal timing of pulmonary valve replacement in patients with chronic pulmonary regurgitation is still unknown. There are several options for surgical pulmonary valve replacement. However, no ideal pulmonary valve substitute exists currently and most of the surgically implanted pulmonary valves will eventually require re-replacement. This article will review options and timing of surgical pulmonary valve insertion in patients with chronic pulmonary regurgitation after repair of tetralogy of Fallot.
Collapse
|
44
|
Ferraz Cavalcanti PE, Sá MPBO, Santos CA, Esmeraldo IM, Escobar RRD, Menezes AMD, Azevedo OMD, Vasconcelos Silva FPD, Lins RFDA, Lima RDC. Pulmonary Valve Replacement After Operative Repair of Tetralogy of Fallot. J Am Coll Cardiol 2013; 62:2227-43. [DOI: 10.1016/j.jacc.2013.04.107] [Citation(s) in RCA: 181] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 04/07/2013] [Accepted: 04/30/2013] [Indexed: 11/30/2022]
|
45
|
McKenzie ED, Maskatia SA, Mery C. Surgical management of tetralogy of fallot: in defense of the infundibulum. Semin Thorac Cardiovasc Surg 2013; 25:206-12. [PMID: 24331142 DOI: 10.1053/j.semtcvs.2013.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2013] [Indexed: 11/11/2022]
Abstract
Surgical treatment of the Tetralogy of Fallot (ToF) is one of the great successes of medicine and also a topic of controversy. Different strategies have been proposed, including age-based (neonatal) management strategies as well as anatomic-based management strategies. Regardless of the management strategy entailed, the surgical management of ToF has considerably evolved over the years. As a result, patients can now expect excellent early results with survival approaching 100% for those without genetic syndromes. The goals of current surgical therapy should be to mitigate the late right ventricular (RV) dysfunction that may occur by minimizing the extent of surgical injury during the intial repair. As the surgical techniques continue to advance, the outcomes will continue to improve.
Collapse
Affiliation(s)
- E Dean McKenzie
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas..
| | - Shiraz A Maskatia
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Carlos Mery
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
46
|
Zaragoza-Macias E, Stout KK. Management of Pulmonic Regurgitation and Right Ventricular Dysfunction in the Adult with Repaired Tetralogy of Fallot. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2013; 15:575-86. [DOI: 10.1007/s11936-013-0258-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
47
|
Abbas JR, Hoschtitzky JA. Which is the best tissue valve used in the pulmonary position, late after previous repair of tetralogy of Fallot? Interact Cardiovasc Thorac Surg 2013; 17:854-60. [PMID: 23929900 DOI: 10.1093/icvts/ivt332] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: which is the best tissue valve for use in the pulmonary position, late after previous repair of tetralogy of Fallot? Altogether 141 papers were found using the reported search, of which 13 represented the best evidence to answer the clinical question. In addition to this, 1 paper was found by searching the reference lists of the relevant papers. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude from the best evidence available that homograft valves function well in the pulmonary position late after Tetralogy of Fallot (TOF) repair. This is particularly evident in the larger studies where the patients were only treated with homografts. It has been suggested that Homografts are better than xenografts and this has not been statistically shown. Two articles have suggested that xenografts outperform homografts however, in both studies these results were not statistically significant. Furthermore, early indications suggest that porcine valves may be better than bovine pericardial valves but a better longer term follow-up is certainly required to demonstrate this. It is important to realize also that when comparing the effectiveness of these valves in the pulmonary position, one cannot ignore confounding factors. The most important of these include timing of operation, age of patient, valve size, immunological factors, operative complexity and also postoperative valvular gradients. The timing of these operations has always been an area of great controversy illustrated by varied guidelines. There is no general consensus regarding whether there is even a role of pulmonary valve replacement late after TOF repair. Further weakening any conclusions that may be drawn based on current best evidence is the lack of strong follow-up data (transvalvular gradients and right ventricular (RV) volumetric data). New research is required with comparisons using objective clinical parameters in order to more effectively answer our clinical question.
Collapse
Affiliation(s)
- Jonathan Raihan Abbas
- Congenital Heart Surgery, Adult Congenital Heart Disease Unit, Central Manchester Foundation Trust, Manchester UK
| | | |
Collapse
|
48
|
Roche SL, Redington AN. The Failing Right Ventricle in Congenital Heart Disease. Can J Cardiol 2013; 29:768-78. [DOI: 10.1016/j.cjca.2013.04.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 04/18/2013] [Accepted: 04/18/2013] [Indexed: 01/04/2023] Open
|
49
|
QRS Complex Enlargement as a Predictor of Ventricular Arrhythmias in Patients Affected by Surgically Treated Tetralogy of Fallot: A Comprehensive Literature Review and Historical Overview. ISRN CARDIOLOGY 2013; 2013:782508. [PMID: 23509638 PMCID: PMC3590565 DOI: 10.1155/2013/782508] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Accepted: 01/16/2013] [Indexed: 12/01/2022]
Abstract
Tetralogy of Fallot (TOF) is a congenital heart disease frequently treated by surgical repair to relieve symptoms and improve survival. However, despite the performing of an optimal surgical repair, TOF patients are at times characterized by a poor long-term survival rate, likely due to cardiac causes such as ventricular arrhythmias, with subsequent sudden death. In the 80s it was irrefutably demonstrated that QRS prolongation ≥180 msec at basal electrocardiogram is a strong predictor for refining risk stratification for ventricular tachycardia in these patients. The aim of this research was to undertake a review of all studies conducted to assess the impact of QRS duration on the development of life-threatening ventricular arrhythmias in repaired TOF subjects.
Collapse
|
50
|
Abstract
Relief of right ventricular outflow tract obstruction in tetralogy of Fallot or similar physiology often results in pulmonary regurgitation. The resultant chronic volume overload can lead to right ventricular dilatation, biventricular dysfunction, heart failure symptoms, arrhythmias, and sudden death. Although pulmonary valve replacement can lead to improvement in functional class and a substantial decrease or normalisation of right ventricular volumes, the optimal timing of pulmonary valve replacement is not well defined. Benefits of pulmonary valve replacement have to be weighed against the risks of this procedure, including subsequent reoperation. This article will review the benefits and risks of pulmonary valve replacement, options for pulmonary valve substitute, and timing of pulmonary valve replacement in patients with chronic pulmonary regurgitation after relief of right ventricular outflow tract obstruction.
Collapse
|