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American Heart Journal

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Ventricular geometric characteristics and functional benefit of mild right ventricular outflow tract obstruction in patients with significant pulmonary regurgitation after repair of tetralogy of Fallot - 22/03/14

Doi : 10.1016/j.ahj.2013.12.026 
Chun-An Chen, MD, PhD a, g, Ssu-Yuan Chen, MD, PhD b, g, Jou-Kou Wang, MD, PhD a, Wen-Yih Isaac Tseng, MD, PhD c, Hsin-Hui Chiu, MD a, d, Chung-I Chang, MD e, Ing-Sh Chiu, MD, PhD e, Yih-Sharng Chen, MD, PhD e, Ming-Chun Yang, MD f, Chun-Wei Lu, MD a, Ming-Tai Lin, MD, PhD a, Mei-Hwan Wu, MD, PhD a, ⁎
a Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan 
b Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan 
c Center for Optoelectronic Biomedicine, College of Medicine, National Taiwan University, Taipei, Taiwan 
d Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan 
e Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan 
f Department of Pediatrics, E-DA hospital and I-SHOU University, Kaohsiung, Taiwan 

⁎Reprint requests: Mei-Hwan Wu, MD, PhD, Department of Pediatrics, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan.

Riassunto

Background

Right ventricular (RV) outflow tract obstruction (RVOTO) might protect the RV from adverse remodeling caused by significant pulmonary regurgitation (PR) in patients with repaired tetralogy of Fallot (rTOF), but the underlying mechanisms and influences on exercise tolerance remain unclear. This study sought to investigate the impacts from mild RVOTO on ventricular remodeling and exercise capacity in rTOF.

Methods

Eighty-five rTOF patients with a PR fraction ≥20% were assessed with cardiac magnetic resonance, cardiopulmonary exercise test, and echocardiography. Patients with a peak RVOT pressure gradient 20–50 mmHg were considered to have mild RVOTO (n = 29), while those with a gradient <20 mmHg had isolated PR (n = 56).

Results

Comparing to patients with isolated PR, patients with combined PR and mild RVOTO had smaller RV and RVOT dimension, better RV and left ventricular (LV) ejection fraction (EF), and superior exercise capacity. PR severity and RV mass/volume ratio were similar between these 2 groups. LVEF coupled with RVEF only in patients with isolated PR. In multivariate analysis, smaller RVOT dimension was independently related to smaller RV dimension (P < .001) and higher RVEF (P = .005). Furthermore, mild RVOTO was independently associated with higher peak oxygen consumption (P = .014) and oxygen uptake efficiency slope (P = .005).

Conclusions

Patients with combined PR and mild RVOTO had better RV remodeling and exercise capacity compared to those with isolated PR. Our findings confirm the benefits from mild residual RVOTO support a policy of conservative RVOTO relief at repair.

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Vol 167 - N° 4

P. 555-561 - aprile 2014 Ritorno al numero
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