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Differential Impact of Pulmonary Regurgitation on Patients With Surgically Repaired Pulmonary Stenosis Versus Tetralogy of Fallot

Published:November 05, 2015DOI:https://doi.org/10.1016/j.amjcard.2015.10.025
      Patients with repaired pulmonary stenosis (PS) or tetralogy of Fallot (TOF) both develop pulmonary regurgitation (PR) leading to right ventricular (RV) dilatation and dysfunction. We aimed to characterize differential effects of chronic PR in these populations. Patients with surgically repaired PS were matched 1:2 by age and PR fraction with patients with TOF. Patients with previous pulmonary valve replacement were excluded. Cardiovascular magnetic resonance data were compared; peak longitudinal and circumferential systolic strain by feature tracking were compared to evaluate differential contribution of the RV sinus and outflow tract, respectively. PS (n = 24, 41 ± 13 years old) and TOF (n = 47, 39 ± 13 years old) patients did not differ in RV end-diastolic volume (153 ± 45 vs 154 ± 45 ml/m2, p = 0.99) or diastolic function. However, patients with PS had preserved RV ejection fraction (54.3 ± 4.4% vs 48.0 ± 7.1%, p <0.0001). Differences were greater in RV circumferential (−15.8 ± 3.3 vs −11.8 ± 3.4, p <0.0001) than longitudinal strain (−18.0 ± 3.8 vs −15.9 ± 3.8, p = 0.04), with particular decrease in the infundibulum (−17.4 ± 7.5 vs −6.8 ± 6.3, p <0.0001). Late gadolinium enhancement in the RV outflow tract was more frequent in patients with TOF (70.2% vs 45.8%, p = 0.001). In conclusion, surgical repair of PS leads to similar RV dilatation and diastolic dysfunction compared to patients with TOF, but differential effects on ventricular systolic function, largely related to differences in the outflow tract. With different patterns of scarring and ventricular remodeling, further study is needed to clarify whether criteria for pulmonary valve replacement in patients with PS should differ from those with TOF.
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      References

        • Keane J.F.
        • Donald C.
        Pulmonary stenosis.
        in: Keane J.F. Nadas' Pediatric Cardiology. Saunders Elsevier Inc, Philadelphia2006: 549-558
        • Jaggers J.
        • Barrett C.
        • Landeck B.
        Pulmonary stenosis and insufficiency.
        in: da Cruz E.M. Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care. Springer, London2014: 1557-1576
        • Cuypers J.A.
        • Witsenburg M.
        • van der Linde D.
        • Roos-Hesselink J.W.
        Pulmonary stenosis: update on diagnosis and therapeutic options.
        Heart. 2013; 99: 339-347
        • Voet A.
        • Rega F.
        • de Bruaene A.V.
        • Troost E.
        • Gewillig M.
        • Van Damme S.
        • Budts W.
        Long-term outcome after treatment of isolated pulmonary valve stenosis.
        Int J Cardiol. 2012; 156: 11-15
        • Roos-Hesselink J.W.
        • Meijboom F.J.
        • Spitaels S.E.
        • van Domburg R.T.
        • van Rijen E.H.
        • Utens E.M.
        • Bogers A.J.
        • Simoons M.L.
        Long-term outcome after surgery for pulmonary stenosis (a longitudinal study of 22–33 years).
        Eur Heart J. 2006; 27: 482-488
        • Therrien J.
        • Marx G.R.
        • Gatzoulis M.A.
        Late problems in tetralogy of Fallot–recognition, management, and prevention.
        Cardiol Clin. 2002; 20: 395-404
        • Gatzoulis M.A.
        • Balaji S.
        • Webber S.A.
        • Siu S.C.
        • Hokanson J.S.
        • Poile C.
        • Rosenthal M.
        • Nakazawa M.
        • Moller J.H.
        • Gillete P.C.
        • Webb G.D.
        • Redington A.N.
        Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study.
        Lancet. 2000; 356: 975-981
        • Gatzoulis M.A.
        • Elliott J.T.
        • Guru V.
        • Siu S.C.
        • Warsi M.A.
        • Webb G.D.
        • Williams W.G.
        • Liu P.
        • McLaughlin P.R.
        Right and left ventricular systolic function late after repair of tetralogy of Fallot.
        Am J Cardiol. 2000; 86: 1352-1357
        • Valente A.M.
        • Gauvreau K.
        • Assenza G.E.
        • Babu-Narayan S.V.
        • Evans S.P.
        • Gatzoulis M.
        • Groenink M.
        • Inuzuka R.
        • Kilner P.J.
        • Koyak Z.
        • Landzberg M.J.
        • Mulder B.
        • Powell A.J.
        • Wald R.
        • Geva T.
        Rationale and design of an international multicenter registry of patients with repaired tetralogy of Fallot to define risk factors for late adverse outcomes: the INDICATOR cohort.
        Pediatr Cardiol. 2013; 34: 95-104
        • Frigiola A.
        • Hughes M.
        • Turner M.
        • Taylor A.
        • Marek J.
        • Giardini A.
        • Hsia T.Y.
        • Bull K.
        Physiologic and phenotypic characteristics of late survivors of tetralogy of Fallot repair who are free from pulmonary valve replacement.
        Circulation. 2013; 128: 1861-1868
        • Wald R.M.
        • Altaha M.A.
        • Alvarez N.
        • Caldarone C.A.
        • Cavallé-Garrido T.
        • Dallaire F.
        • Drolet C.
        • Grewal J.
        • Hancock Friesen C.L.
        • Human D.G.
        • Hickey E.
        • Kayedpour C.
        • Khairy P.
        • Kovacs A.H.
        • Lebovic G.
        • McCrindle B.W.
        • Nadeem S.N.
        • Patton D.J.
        • Redington A.N.
        • Silversides C.K.
        • Tham E.B.
        • Therrien J.
        • Warren A.E.
        • Wintersperger B.J.
        • Vonder Muhll I.F.
        • Farkouh M.E.
        Rationale and design of the Canadian outcomes registry late after tetralogy of Fallot repair: the CORRELATE study.
        Can J Cardiol. 2014; 30: 1436-1443
        • Geva T.
        Repaired tetralogy of Fallot: the roles of cardiovascular magnetic resonance in evaluating pathophysiology and for pulmonary valve replacement decision support.
        J Cardiovasc Magn Reson. 2011; 13: 1-24
        • Geva T.
        Indications for pulmonary valve replacement in repaired tetralogy of Fallot: the quest continues.
        Circulation. 2013; 128: 1855-1857
        • Knauth A.L.
        • Gauvreau K.
        • Powell A.J.
        • Landzberg M.J.
        • Walsh E.P.
        • Lock J.E.
        • del Nido P.J.
        • Geva T.
        Ventricular size and function assessed by cardiac MRI predict major adverse clinical outcomes late after tetralogy of Fallot repair.
        Heart. 2008; 94: 211-216
        • Alfakih K.
        • Plein S.
        • Bloomer T.
        • Jones T.
        • Ridgway J.
        • Silvananthan M.
        Comparison of right ventricular volume measurements between axial and short axis orientation using steady-state free precession magnetic resonance imaging.
        J Magn Reson Imaging. 2003; 18: 25-32
        • Kempny A.
        • Fernández-Jiménez R.
        • Orwat S.
        • Schuler P.
        • Bunck A.C.
        • Maintz D.
        • Baumgartner H.
        • Diller G.P.
        Quantification of biventricular myocardial function using cardiac magnetic resonance feature tracking, endocardial border delineation and echocardiographic speckle tracking in patients with repaired tetralogy of Fallot and healthy controls.
        J Cardiovasc Magn Reson. 2012; 14: 14-32
        • Redington A.N.
        Determinants and assessment of pulmonary regurgitation in tetralogy of Fallot: practice and pitfalls.
        Cardiol Clin. 2006; 24: 631-639
        • Zdradzinski M.J.
        • Qureshi A.M.
        • Stewart R.
        • Pettersson G.
        • Krasuski R.A.
        Comparison of long-term postoperative sequelae in patients with tetralogy of Fallot versus isolated pulmonic stenosis.
        Am J Cardiol. 2014; 114: 300-304
        • Yoo B.W.
        • Kim J.O.
        • Kim Y.J.
        • Choi J.Y.
        • Park H.K.
        • Park Y.H.
        • Sul J.H.
        Impact of pressure load caused by right ventricular outflow tract obstruction on right ventricular volume overload in patients with repaired tetralogy of Fallot.
        J Thorac Cardiovasc Surg. 2012; 143: 1299-1304
        • Puranik R.
        • Tsang V.
        • Lurz P.
        • Muthurangu V.
        • Offen S.
        • Frigiola A.
        • Norman W.
        • Walker F.
        • Bonhoeffer P.
        • Taylor A.M.
        Long-term importance of right ventricular outflow tract patch function in patients with pulmonary regurgitation.
        J Thorac Cardiovasc Surg. 2012; 143: 1103-1107
        • Scherptong R.W.
        • Mollema S.A.
        • Blom N.A.
        • Kroft L.J.
        • de Roos A.
        • Vliegen H.W.
        • van der Wall E.E.
        • Bax J.J.
        • Holman E.R.
        Right ventricular peak systolic longitudinal strain is a sensitive marker for right ventricular deterioration in adult patients with tetralogy of Fallot.
        Int J Cardiovasc Imaging. 2009; 25: 669-676
        • Alghamdi M.H.
        • Mertens L.
        • Lee W.
        • Yoo S.J.
        • Grosse-Wortmann L.
        Longitudinal right ventricular function is a better predictor of right ventricular contribution to exercise performance than global or outflow tract ejection fraction in tetralogy of Fallot: a combined echocardiography and magnetic resonance study.
        Eur Heart J Cardiovasc Imaging. 2013; 14: 235-239
        • Lu J.C.
        • Ghadimi Mahani M.
        • Agarwal P.P.
        • Cotts T.B.
        • Dorfman A.L.
        Usefulness of right ventricular free wall strain to predict quality of life in “repaired” tetralogy of Fallot.
        Am J Cardiol. 2013; 111: 1644-1649
        • Mercer-Rosa L.
        • Ingall E.
        • Zhang X.
        • McBride M.
        • Kawut S.
        • Fogel M.
        • Paridon S.
        • Goldmuntz E.
        The impact of pulmonary insufficiency on the right ventricle: a comparison of isolated valvar pulmonary stenosis and tetralogy of Fallot.
        Pediatr Cardiol. 2015; 36: 796-801
        • Wald R.M.
        • Haber I.
        • Wald R.
        • Valente A.M.
        • Powell A.J.
        • Geva T.
        Effects of regional dysfunction and late gadolinium enhancement on global right ventricular function and exercise capacity in patients with repaired tetralogy of Fallot.
        Circulation. 2009; 119: 1370-1377
        • Geva T.
        • Sandweiss B.M.
        • Gauvreau K.
        • Lock J.E.
        • Powell A.J.
        Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging.
        J Am Coll Cardiol. 2004; 43: 1068-1074
        • Meadows J.
        • Powell A.J.
        • Geva T.
        • Dorfman A.
        • Gauvreau K.
        • Rhodes J.
        Cardiac magnetic resonance imaging correlates of exercise capacity in patients with surgically repaired tetralogy of Fallot.
        Am J Cardiol. 2007; 100: 1446-1450
        • Lu J.C.
        • Cotts T.B.
        • Agarwal P.P.
        • Attili A.K.
        • Dorfman A.L.
        Relation of right ventricular dilation, age of repair, and restrictive right ventricular physiology with patient-reported quality of life in adolescents and adults with repaired tetralogy of Fallot.
        Am J Cardiol. 2010; 106: 1798-1802
        • Lee W.
        • Yoo S.J.
        • Roche S.L.
        • Kantor P.
        • van Arsdell G.
        • Park E.A.
        • Redington A.
        • Grosse-Wortmann L.
        Determinants and functional impact of restrictive physiology after repair of tetralogy of Fallot: new insights from magnetic resonance imaging.
        Int J Cardiol. 2013; 167: 1347-1353