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Long ZB, Punn R, Zhang Y, Arunamata AA, Asija R, Ma M, Hanley FL, McElhinney DB. Right Ventricular and Outflow Tract Functional Characteristics After Repair of Tetralogy of Fallot with Major Aortopulmonary Collaterals. Pediatr Cardiol 2024; 45:795-803. [PMID: 38360921 DOI: 10.1007/s00246-024-03412-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/08/2024] [Indexed: 02/17/2024]
Abstract
This study describes right ventricle (RV) characteristics and right ventricle to pulmonary artery (RV-PA) conduit function pre- and post-repair in patients with tetraology of Fallot with major aortopulmonary collaterals (TOF/MAPCAs). We reviewed patients who underwent single-stage, complete unifocalization, and repair of TOF/MAPCAs between 2006 and 2019 with available pre- and early postoperative echocardiograms. For a subset of patients, 6-12 month follow-up echocardiogram was available. RV and left ventricle (LV) characteristics and RV-PA conduit function were reviewed. Wilcoxon signed rank test and McNemar's test were used. 170 patients were reviewed, 46 had follow-up echocardiograms. Tricuspid valve annular plane systolic excursion (TAPSE) Z-scores were reduced from pre- (Z-score 0.01) to post-repair (Z-score -4.5, p < 0.001), improved but remained abnormal at follow-up (Z-score -4.0, p < 0.001). RV fractional area change (FAC) and LV ejection fraction were not significantly different before and after surgery. Conduit regurgitation was moderate or greater in 11% at discharge, increased to 65% at follow-up. RV-PA conduit failure (severe pulmonary stenosis or severe pulmonary regurgitation) was noted in 61, and 63% had dilated RV (diastolic RV area Z-score > 2) at follow-up. RV dilation correlated with the severe conduit regurgitation (p = 0.018). Longitudinal RV function was reduced after complete repair of TOF/MAPCAs, with decreased TAPSE and preserved FAC and LV ejection fraction. TAPSE improved but did not normalize at follow-up. Severe RV-PA conduit dysfunction was observed prior to discharge in 11% of patients and in 61% at follow-up. RV dilation was common at follow-up, especially in the presence of severe conduit regurgitation.
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Affiliation(s)
- Zsofia B Long
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA.
- Pediatric Cardiology, Stanford University School of Medicine, 750 Welch Road, Suite 325, Palo Alto, CA, 94304-5731, USA.
| | - Rajesh Punn
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
| | - Yulin Zhang
- Clinical and Translational Research Program, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
| | - Alisa A Arunamata
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
| | - Ritu Asija
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
| | - Michael Ma
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
| | - Frank L Hanley
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
| | - Doff B McElhinney
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
- Clinical and Translational Research Program, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
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