Introduction Pulmonary regurgitation (PR) leading to right ventricular enlargement is a significant residual haemodynamic problem affecting patients with tetralogy of Fallot (TOF). We aimed to assess changes in right ventricular (RV) haemodynamics, secondary to PR following TOF repair. We also investigated changes in RV haemodynamics following pulmonary valve replacement (PVR) for PR. We compared differences in RV measurements made using cardiac MRI to those made using 2D echocardiography.
Methods 31 repaired TOF patients (12 female, 19 male) of mean age 31(±12.2) were studied. Right ventricular end diastolic volume (RVEDV) and right ventricular end systolic volume (RVESV), right ventricular ejection fraction (RVEF), PR and aortic root diameter were measured on CMR and QRS duration was measured on ECG. RVEDV and RVESV were also measured using 2D echocardiography and the measurements compared with those obtained using CMR.
Results After TOF repair RVEDV increased over time at a rate of 3.3ml/m2/year (n = 23). There was also a significant increase in aortic root diameter between measurements, at a rate of 0.32mm/year. RVEDV was compared between patients about to undergo PVR (n = 5) and patients continuing on surveillance (n = 23). Although the mean RVEDV was larger in the prePVR group (162.7 vs 131.1ml/m2), this was not statistically significant (Table 1). RVESV (p = 0.295), RVEF (p = 0.476), PR (p = 0.532) and QRS duration (p = 0.361) did not show any significant change. Following PVR, RVEDV decreased by a mean 49.3ml/m2 (±22.5) as a result of eliminating or improving PR (p = 0.004) (n = 5). There was a significant difference between CMR and 2D echocardiography RVEDV and RVESV measurements (p= <0.001) (n = 31) (Table 2).
Conclusions Repaired TOF patients show a gradual increase in RVEDV in the years following total repair. A PVR can correct this as it significantly decreases RVEDV to within the normal range. 2D echocardiography is not as accurate as CMR in assessing the right ventricle of repaired TOF patients.
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