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Timely Pulmonary Valve Replacement May Allow Preservation of Left Ventricular Circumferential Strain in Patients with Tetralogy of Fallot


Velasco Forte, Marí Nieves; Burkhardt, Barbara E U; Durairaj, Saravanan; Rafiq, Isma; Valverde, Israel; Tandon, Animesh; Simpson, John; Hussain, Tarique (2017). Timely Pulmonary Valve Replacement May Allow Preservation of Left Ventricular Circumferential Strain in Patients with Tetralogy of Fallot. Frontiers in Pediatrics, 5:39.

Abstract

INTRODUCTION: Patients with Tetralogy of Fallot (TOF) and pulmonary insufficiency and a dilated right ventricle (RV) may suffer from a reduction in left ventricular (LV) performance. It is not clear whether timely pulmonary valve replacement (PVR) preserves LV mechanics.
METHODS: Ten TOF patients who underwent PVR were identified from hospital records, and pre- and postoperative cardiac magnetic resonance images were post-processed with a semi-automatic tissue tracking software. LV circumferential strain, time to peak strain, and torsion were compared before and after PVR. A control group of 10 age-matched normal volunteers was assessed as a comparison.
RESULTS: LV circumferential strain did not change before vs. after PVR (basal -18.3 ± 3.7 vs. -20.5 ± 3%, = 0.082; mid-ventricular -18.4 ± 3.6 vs. -19.1 ± 2%, = 0.571; apical -22.7 ± 5.2 vs. -22.1 ± 4%; = 0.703). There was also no difference seen between the baseline strain and normal controls (control basal -18.2 ± 3.3%, = 0.937; mid -18 ± 3.2%, = 0.798; apex -24.1 ± 5%, = 0.552). LV torsion remained unchanged from baseline to post PVR [systolic 2.75 (1.23-9.51) °/cm vs. 2.3 ± 1.2°/cm, = 0.285; maximum 5.5 ± 3.5°/cm vs. 2.34 (1.37-8.07) °/cm, = 0.083]. There was no difference in time to measured peak LV circumferential strain before vs. after PVR (basal 0.44 ± 0.1 vs. 0.43 ± 0.05, = 0.912; mid-ventricular 0.42 ± 0.08 vs. 0.38 ± 0.06, = 0.186; apical 0.40 ± 0.08 vs. 0.40 ± 0.06, = 0.995). At the same time, pulmonary regurgitation and RV end-diastolic and end-systolic volume indices decreased and LV end-diastolic volume increased after PVR. RV and LV ejection fractions remained constant.
CONCLUSION: PVR allows for favorable remodeling of both ventricular volumes for TOF patients with significant pulmonary regurgitation. In this cohort, LV myocardial functional parameters such as circumferential strain, time to peak strain, and LV torsion were normal at baseline and remain unchanged after PVR.

Abstract

INTRODUCTION: Patients with Tetralogy of Fallot (TOF) and pulmonary insufficiency and a dilated right ventricle (RV) may suffer from a reduction in left ventricular (LV) performance. It is not clear whether timely pulmonary valve replacement (PVR) preserves LV mechanics.
METHODS: Ten TOF patients who underwent PVR were identified from hospital records, and pre- and postoperative cardiac magnetic resonance images were post-processed with a semi-automatic tissue tracking software. LV circumferential strain, time to peak strain, and torsion were compared before and after PVR. A control group of 10 age-matched normal volunteers was assessed as a comparison.
RESULTS: LV circumferential strain did not change before vs. after PVR (basal -18.3 ± 3.7 vs. -20.5 ± 3%, = 0.082; mid-ventricular -18.4 ± 3.6 vs. -19.1 ± 2%, = 0.571; apical -22.7 ± 5.2 vs. -22.1 ± 4%; = 0.703). There was also no difference seen between the baseline strain and normal controls (control basal -18.2 ± 3.3%, = 0.937; mid -18 ± 3.2%, = 0.798; apex -24.1 ± 5%, = 0.552). LV torsion remained unchanged from baseline to post PVR [systolic 2.75 (1.23-9.51) °/cm vs. 2.3 ± 1.2°/cm, = 0.285; maximum 5.5 ± 3.5°/cm vs. 2.34 (1.37-8.07) °/cm, = 0.083]. There was no difference in time to measured peak LV circumferential strain before vs. after PVR (basal 0.44 ± 0.1 vs. 0.43 ± 0.05, = 0.912; mid-ventricular 0.42 ± 0.08 vs. 0.38 ± 0.06, = 0.186; apical 0.40 ± 0.08 vs. 0.40 ± 0.06, = 0.995). At the same time, pulmonary regurgitation and RV end-diastolic and end-systolic volume indices decreased and LV end-diastolic volume increased after PVR. RV and LV ejection fractions remained constant.
CONCLUSION: PVR allows for favorable remodeling of both ventricular volumes for TOF patients with significant pulmonary regurgitation. In this cohort, LV myocardial functional parameters such as circumferential strain, time to peak strain, and LV torsion were normal at baseline and remain unchanged after PVR.

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Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Children's Hospital Zurich > Medical Clinic
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2017
Deposited On:28 Feb 2018 14:26
Last Modified:14 Mar 2018 18:02
Publisher:Frontiers Research Foundation
ISSN:2296-2360
OA Status:Gold
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:https://doi.org/10.3389/fped.2017.00039
Related URLs:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328989/
PubMed ID:28293551
Other Identification Number:PMCID: PMC5328989

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