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Bhaskaran A, Campbell T, Trivic I, Tanous DJ, Kumar S. Left Ventricular Outflow Tract Ventricular Tachycardia Late Post-Arterial Switch for D-Transposition of the Great Arteries. JACC Clin Electrophysiol 2019; 5:1096-1097. [PMID: 31537343 DOI: 10.1016/j.jacep.2019.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/05/2019] [Accepted: 06/05/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Ashwin Bhaskaran
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Timothy Campbell
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia; Westmead Applied Research Centre, University of Sydney, Westmead, New South Wales, Australia
| | - Ivana Trivic
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia; Westmead Applied Research Centre, University of Sydney, Westmead, New South Wales, Australia
| | - David J Tanous
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia; Westmead Applied Research Centre, University of Sydney, Westmead, New South Wales, Australia.
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O'Meagher S, Seneviratne M, Skilton MR, Munoz PA, Robinson PJ, Malitz N, Tanous DJ, Celermajer DS, Puranik R. Right Ventricular Mass is Associated with Exercise Capacity in Adults with Repaired Tetralogy of Fallot. Pediatr Cardiol 2015; 36:1225-31. [PMID: 25795311 DOI: 10.1007/s00246-015-1150-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 03/13/2015] [Indexed: 11/25/2022]
Abstract
The relationship between exercise capacity and right ventricular (RV) structure and function in adult repaired tetralogy of Fallot (TOF) is poorly understood. We therefore aimed to examine the relationships between cardiac MRI and cardiopulmonary exercise test variables in adult repaired TOF patients. In particular, we sought to determine the role of RV mass in determining exercise capacity. Eighty-two adult repaired TOF patients (age at evaluation 26 ± 10 years; mean age at repair 2.5 ± 2.8 years; 23.3 ± 7.9 years since repair; 53 males) (including nine patients with tetralogy-type pulmonary atresia with ventricular septal defect) were prospectively recruited to undergo cardiac MRI and cardiopulmonary exercise testing. As expected, these repaired TOF patients had RV dilatation (indexed RV end-diastolic volume: 153 ± 43.9 mL/m(2)), moderate-severe pulmonary regurgitation (pulmonary regurgitant fraction: 33 ± 14 %) and preserved left (LV ejection fraction: 59 ± 8 %) and RV systolic function (RV ejection fraction: 51 ± 7 %). Exercise capacity was near-normal (peak work: 88 ± 17 % predicted; peak oxygen consumption: 84 ± 17 % predicted). Peak work exhibited a significant positive correlation with RV mass in univariate analysis (r = 0.45, p < 0.001) and (independent of other cardiac MRI variables) in multivariate analyses. For each 10 g higher RV mass, peak work was 8 W higher. Peak work exhibits a significant positive correlation with RV mass, independent of other cardiac MRI variables. RV mass measured on cardiac MRI may provide a novel marker of clinical progress in adult patients with repaired TOF.
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Affiliation(s)
- Shamus O'Meagher
- Faculty of Medicine, The University of Sydney, Sydney, Australia,
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O'Meagher S, Munoz PA, Muthurangu V, Robinson PJ, Malitz N, Tanous DJ, Celermajer DS, Puranik R. Mechanisms of maintained exercise capacity in adults with repaired tetralogy of Fallot. Int J Cardiol 2014; 177:178-81. [PMID: 25499372 DOI: 10.1016/j.ijcard.2014.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 08/21/2014] [Accepted: 09/15/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND The mechanisms whereby cardiac output is augmented with exercise in adult repaired tetralogy of Fallot (TOF) are poorly characterised. METHODS 16 repaired TOF patients (25 ± 7 years of age) and 8 age and sex matched controls (25 ± 4 years of age) underwent cardiopulmonary exercise testing and then real-time cardiac MRI (1.5 T) at rest and whilst exercising within the scanner, aiming for 30% heart rate reserve (Level 1) and 60% heart rate reserve (Level 2), using a custom-built MRI compatible foot pedal device. RESULTS At rest, TOF patients had severely dilated RVs (indexed RV end-diastolic volume: 149 ± 37 mL/m(2)), moderate-severe PR (regurgitant fraction 35 ± 12%), normal RV fractional area change (FAC) (52 ± 7%) and very mildly impaired exercise capacity (83 ± 15% of predicted maximal work rate). Heart rate and RV FAC increased significantly in TOF patients (75 ± 10 vs 123 ± 17 beats per minute, p<0.001; 44 ± 7 vs 51 ± 10%, p=0.025), and similarly in control subjects (70 ± 11 vs 127 ± 12 beats per minute, p<0.001; 49 ± 7 vs 61 ± 9%, p=0.003), when rest was compared to Level 2. PR fraction decreased significantly but only modestly, from rest to Level 2 in TOF patients (37 ± 15 to 31 ± 15%, p=0.002). Pulmonary artery net forward flow was maintained and did not significantly increase from rest to Level 2 in TOF patients (70 ± 19 vs 69 ± 12 mL/beat, p=0.854) or controls (93 ± 9 vs 95 ± 21 mL/beat, p=0.648). CONCLUSIONS During exercise in repaired TOF subjects with dilated RV and free PR, increased total RV output per minute was facilitated by an increase in heart rate, an increase in RV FAC and a decrease in PR fraction.
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Affiliation(s)
- Shamus O'Meagher
- The University of Sydney, Faculty of Medicine, Sydney, Australia; Royal Prince Alfred Hospital, Department of Cardiology, Sydney, Australia.
| | - Phillip A Munoz
- Royal Prince Alfred Hospital, Department of Respiratory and Sleep Medicine, Sydney, Australia.
| | - Vivek Muthurangu
- UCL Institute of Cardiovascular Science, Centre for Cardiovascular Imaging, London, United Kingdom; Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom.
| | - Peter J Robinson
- Royal Prince Alfred Hospital, Department of Cardiology, Sydney, Australia; Westmead Hospital, Department of Cardiology, Sydney, Australia.
| | | | - David J Tanous
- Royal Prince Alfred Hospital, Department of Cardiology, Sydney, Australia; Westmead Hospital, Department of Cardiology, Sydney, Australia.
| | - David S Celermajer
- The University of Sydney, Faculty of Medicine, Sydney, Australia; Royal Prince Alfred Hospital, Department of Cardiology, Sydney, Australia.
| | - Rajesh Puranik
- The University of Sydney, Faculty of Medicine, Sydney, Australia; Royal Prince Alfred Hospital, Department of Cardiology, Sydney, Australia.
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Dennis M, Laarkson M, Padang R, Tanous DJ, Robinson P, Pressley L, O'Meagher S, Celermajer D, Puranik R. Long term followup of aortic root size after repair of tetralogy of Fallot. Int J Cardiol 2014; 177:136-8. [PMID: 25499358 DOI: 10.1016/j.ijcard.2014.09.113] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 09/20/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Mark Dennis
- Sydney Medical School, University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.
| | - Maarit Laarkson
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Ratnasari Padang
- Sydney Medical School, University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - David J Tanous
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Peter Robinson
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Lynne Pressley
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Shamus O'Meagher
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - David Celermajer
- Sydney Medical School, University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Rajesh Puranik
- Sydney Medical School, University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia; SMRI Imaging, RPAH Medical Centre, Sydney, Australia
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O’Meagher S, Ganigara M, Tanous DJ, Celermajer DS, Puranik R. Progress of right ventricular dilatation in adults with repaired tetralogy of Fallot and free pulmonary regurgitation. IJC Heart & Vessels 2014; 3:28-31. [PMID: 29450166 PMCID: PMC5801270 DOI: 10.1016/j.ijchv.2014.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 02/21/2014] [Indexed: 11/13/2022]
Abstract
Background The time course of progressive dilatation of the right ventricle (RV) in adults with pulmonary regurgitation (PR) late after repair of tetralogy of Fallot (TOF) is poorly characterized. Methods We analysed cardiac MRI data (1.5 T) from 14 adult repaired TOF patients (26 ± 11 years of age) with dilated RVs and known significant PR, on 2 separate visits with a between MRI period of 2.1 ± 1.0 years. Results Indexed RV end diastolic volume (RVEDVi) increased over 2 years (142 ± 19 to 151 ± 20 mL/m2, p = 0.005; change = 8.4 ± 9.3 mL/m2, range = − 6 to 26 mL/m2; annual mL/m2 increase = 4.3 ± 4.6; annual percentage increase = 3.1 ± 3.3%), whilst RV ejection fraction decreased (53 ± 8 to 49 ± 7 %, p = 0.039). RV muscular corpus (RVMC) EDVi significantly increased (130 ± 19 to 138 ± 20 mL/m2, p = 0.014), whereas RV outflow tract (RVOT) EDVi did not (12 ± 7 vs 13 ± 6 mL/m2, p = 0.390). No other RV or LV measures significantly changed during the inter-MRI period. The change in RVEDVi correlated significantly with LV end diastolic volume (r = − 0.582, p = 0.029), RVEDVi:LVEDVi (r = 0.6, p = 0.023) and RVMC EDVi (r = 0.9, p < 0.001) but not RVOT EDVi (r = 0.225, p = 0.459). Conclusions Adult repaired TOF patients with free PR experienced a mean 3.1%, or 4.3 mL/m2, annual increase in RVEDVi, unrelated to the initial RVEDVi or PR fraction. The increase in RVEDVi was due to RVMC rather than RVOT dilatation. This provides a guide to the frequency of MR surveillance and insights into the natural history of progressive RV dilatation in this setting.
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Padang R, Dennis M, Semsarian C, Bannon PG, Tanous DJ, Celermajer DS, Puranik R. Detection of Serious Complications by MR Imaging in Asymptomatic Young Adults with Repaired Coarctation of the Aorta. Heart Lung Circ 2014; 23:332-8. [DOI: 10.1016/j.hlc.2013.10.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 10/03/2013] [Indexed: 11/25/2022]
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O'Meagher S, Ganigara M, Munoz P, Tanous DJ, Chard RB, Celermajer DS, Puranik R. Right ventricular outflow tract enlargement prior to pulmonary valve replacement is associated with poorer structural and functional outcomes, in adults with repaired Tetralogy of Fallot. Heart Lung Circ 2013; 23:482-8. [PMID: 24345378 DOI: 10.1016/j.hlc.2013.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 11/18/2013] [Accepted: 11/19/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pulmonary valve replacement (PVR) is commonly performed late after Tetralogy of Fallot (TOF) repair. We examined the effects of PVR on cardiac structure, function and exercise capacity in adults with repaired TOF. METHODS Eighteen adult patients with repaired TOF and severe pulmonary regurgitation (PR) with right ventricular (RV) dilatation requiring PVR for clinical reasons (age; 25±8 years) were recruited to undergo cardiac MRI (1.5T) and cardiopulmonary exercise testing before and 14±3 months after PVR. RESULTS Reduced indexed RV end-diastolic volume (RVEDVi; 186±32mL/m(2) pre-op vs 114±20mL/m(2) post-op, p<0.001) was observed after PVR. "Normalisation" of RVEDVi (≤108mL/m(2)) was achieved in only seven of 18 patients. Pre-PVR RVEDVi correlated with post-operative change in RVEDVi (change=-72.1±20.4mL/m(2), r=-0.815, p<0.001). Exercise capacity remained high-normal post-PVR (% predicted maximal workload: 93±16% vs 91±12%, p=0.5). Regional RV volumes were assessed; RV outflow tract (RVOT) volumes were compared to the RV muscular corpus. Large pre-PVR RVOT volumes correlated negatively with post-surgical RV ejection fraction, peak VO2 and delta VO2 at anaerobic threshold (p<0.05 for all). CONCLUSIONS Normalisation of RV volume is unlikely to be achieved above a pre-PVR RVEDVi of 165mL/m(2) or more. In particular, an enlarged RVOT prior to PVR predicts suboptimal structural and functional outcomes.
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Affiliation(s)
- Shamus O'Meagher
- The University of Sydney, Faculty of Medicine, Sydney, Australia; Royal Prince Alfred Hospital, Department of Cardiology, Sydney, Australia.
| | - Madhusudan Ganigara
- The University of Sydney, Faculty of Medicine, Sydney, Australia; The Children's Hospital at Westmead, Department of Cardiology, Sydney, Australia
| | - Phillip Munoz
- The University of Sydney, Faculty of Medicine, Sydney, Australia; Royal Prince Alfred Hospital, Department of Respiratory and Sleep Medicine, Sydney, Australia
| | - David J Tanous
- The University of Sydney, Faculty of Medicine, Sydney, Australia; Westmead Hospital, Department of Cardiology, Sydney, Australia
| | - Richard B Chard
- The University of Sydney, Faculty of Medicine, Sydney, Australia; Westmead Hospital, Department of Cardiology, Sydney, Australia
| | - David S Celermajer
- The University of Sydney, Faculty of Medicine, Sydney, Australia; Royal Prince Alfred Hospital, Department of Cardiology, Sydney, Australia
| | - Rajesh Puranik
- The University of Sydney, Faculty of Medicine, Sydney, Australia; Royal Prince Alfred Hospital, Department of Cardiology, Sydney, Australia
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O'Meagher S, Munoz PA, Alison JA, Young IH, Tanous DJ, Celermajer DS, Puranik R. Exercise capacity and stroke volume are preserved late after tetralogy repair, despite severe right ventricular dilatation. Heart 2012; 98:1595-9. [DOI: 10.1136/heartjnl-2012-302147] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Geary GG, Tanous DJ, Ross DL. Incidence of renal artery stenosis in 2,111 patients undergoing coronary angiography: A model of predictive risk of renal artery stenosis. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)80029-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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