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Open Access 01-06-2020 | Echocardiography | Original Article

Left and Right Ventricular Impairment Shortly After Correction of Tetralogy of Fallot

Authors: Covadonga Terol, Vivian P. Kamphuis, Mark G. Hazekamp, Nico A. Blom, Arend D. J. Ten Harkel

Published in: Pediatric Cardiology | Issue 5/2020

Abstract

Surgical repair of Tetralogy of Fallot (ToF) is usually performed in the first months of life with low early postoperative mortality. During long-term follow-up, however, both right (RV) and left ventricular (LV) performances may deteriorate. Tissue Doppler imaging (TDI) and speckle tracking echocardiography (ST) can unmask a diminished RV and LV performance. The objective of the current study was to assess the cardiac performance before and shortly after corrective surgery in ToF patients using conventional, TDI and ST echocardiographic techniques. Thirty-six ToF patients after surgery were included. Transthoracic echocardiography including TDI and ST techniques was performed preoperatively and at hospital discharge after surgery (10 days to 4 weeks after surgery). Median age at surgery was 7.5 months [5.5–10.9]. Regarding the LV systolic function there was a significant decrease in interventricular septum (IVS) S′ at discharge as compared to preoperatively (pre IVS S′ = 5.4 ± 1.4; post IVS S′ = 3.9 ± 1.2; p < 0.001) and in global longitudinal peak strain (GLS) (pre = − 18.3 ± 3.4; post = − 14.2 ± 4.1; p = 0.003); but not in the fractional shortening (FS). Both conventional and TDI parameters showed a decrease in diastolic function at discharge. Tricuspid Annular Plane Systolic Excursion and RV S′ were significantly lower before discharge. When assessing the RV diastolic performance, only the TDI demonstrated a RV impairment. There was a negative correlation between age at surgery and postoperative LV GLS (R = − 0.41, p = 0.031). There seems to be an impairment in left and right ventricle performance at discharge after ToF corrective surgery compared to preoperatively. This is better determined with TDI and ST strain imaging than with conventional echocardiography.

Jacobs JP, Mayer JE Jr, Pasquali SK, Hill KD, Overman DM, St Louis JD, Kumar SR, Backer CL, Fraser CD, Tweddell JS, Jacobs ML (2018) The society of thoracic surgeons congenital heart surgery database: 2018 update on outcomes and quality. Ann Thorac Surg. https://doi.org/10.1016/j.athoracsur.2018.01.001 CrossRefPubMedPubMedCentral

Villafane J, Feinstein JA, Jenkins KJ, Vincent RN, Walsh EP, Dubin AM, Geva T, Towbin JA, Cohen MS, Fraser C, Dearani J, Rosenthal D, Kaufman B, Graham TP Jr, Adult C, Pediatric Cardiology Section ACoC (2013) Hot topics in tetralogy of Fallot. J Am Coll Cardiol 62(23):2155–2166. https://doi.org/10.1016/j.jacc.2013.07.100 CrossRefPubMed

Broberg CS, Aboulhosn J, Mongeon FP, Kay J, Valente AM, Khairy P, Earing MG, Opotowsky AR, Lui G, Gersony DR, Cook S, Ting JG, Webb G, Gurvitz MZ, Alliance for Adult Research in Congenital C (2011) Prevalence of left ventricular systolic dysfunction in adults with repaired tetralogy of fallot. Am J Cardiol 107(8):1215–1220. https://doi.org/10.1016/j.amjcard.2010.12.026 CrossRefPubMed

de Boer JM, Kuipers IM, Klitsie LM, Blom NA, Ten Harkel AD (2017) Decreased biventricular longitudinal strain shortly after congenital heart defect surgery. Echocardiography 34(3):446–452. https://doi.org/10.1111/echo.13456 CrossRefPubMed

Klitsie LM, Hazekamp MG, Roest AA, Van der Hulst AE, Gesink-van der Veer BJ, Kuipers IM, Blom NA, Ten Harkel AD (2013) Tissue Doppler imaging detects impaired biventricular performance shortly after congenital heart defect surgery. Pediatr Cardiol 34(3):630–638. https://doi.org/10.1007/s00246-012-0513-3 CrossRefPubMed

Klitsie LM, Roest AA, Blom NA, ten Harkel AD (2014) Ventricular performance after surgery for a congenital heart defect as assessed using advanced echocardiography: from doppler flow to 3D echocardiography and speckle-tracking strain imaging. Pediatr Cardiol 35(1):3–15. https://doi.org/10.1007/s00246-013-0802-5 CrossRefPubMed

Cetin I, Tokel K, Varan B, Orun U, Aslamaci S (2009) Evaluation of right ventricular function by using tissue Doppler imaging in patients after repair of tetralogy of fallot. Echocardiography 26(8):950–957. https://doi.org/10.1111/j.1540-8175.2009.00918.x CrossRefPubMed

Li Y, Xie M, Wang X, Lu Q, Zhang L, Ren P (2015) Impaired right and left ventricular function in asymptomatic children with repaired tetralogy of Fallot by two-dimensional speckle tracking echocardiography study. Echocardiography 32(1):135–143. https://doi.org/10.1111/echo.12581 CrossRefPubMed

Menting ME, Eindhoven JA, van den Bosch AE, Cuypers JA, Ruys TP, van Dalen BM, McGhie JS, Witsenburg M, Helbing WA, Geleijnse ML, Roos-Hesselink JW (2014) Abnormal left ventricular rotation and twist in adult patients with corrected tetralogy of Fallot. Eur Heart J Cardiovasc Imaging 15(5):566–574. https://doi.org/10.1093/ehjci/jet244 CrossRefPubMed

10.

Pauliks LB, Valdes-Cruz LM, Perryman R, Scholl FG (2014) Right ventricular wall-motion changes after infant open heart surgery–a tissue Doppler study. Echocardiography 31(2):209–217. https://doi.org/10.1111/echo.12347 CrossRefPubMed

11.

Yamada M, Takahashi K, Kobayashi M, Yazaki K, Takayasu H, Akimoto K, Kishiro M, Inage A, Yoshikawa T, Park IS, Nakanishi K, Kawasaki S, Shimizu T (2017) Mechanisms of left ventricular dysfunction assessed by layer-specific strain analysis in patients with repaired tetralogy of Fallot. Circ J 81(6):846–854. https://doi.org/10.1253/circj.CJ-16-1162 CrossRefPubMed

12.

Marcucci C, Lauer R, Mahajan A (2008) New echocardiographic techniques for evaluating left ventricular myocardial function. Semin Cardiothorac Vasc Anesth 12(4):228–247. https://doi.org/10.1177/1089253208328581 CrossRefPubMed

13.

Forsey J, Friedberg MK, Mertens L (2013) Speckle tracking echocardiography in pediatric and congenital heart disease. Echocardiography 30(4):447–459. https://doi.org/10.1111/echo.12131 CrossRefPubMed

14.

Klitsie LM, Kuipers IM, Roest AA, Van der Hulst AE, Stijnen T, Hazekamp MG, Blom NA, Ten Harkel AD (2013) Disparity in right vs left ventricular recovery during follow-up after ventricular septal defect correction in children. Eur J Cardiothorac Surg 44(2):269–274. https://doi.org/10.1093/ejcts/ezt003 CrossRefPubMed

15.

Klitsie LM, Roest AA, Kuipers IM, Hazekamp MG, Blom NA, Ten Harkel AD (2014) Left and right ventricular performance after arterial switch operation. J Thorac Cardiovasc Surg 147(5):1561–1567. https://doi.org/10.1016/j.jtcvs.2013.07.048 CrossRefPubMed

16.

Kaul S, Tei C, Hopkins JM, Shah PM (1984) Assessment of right ventricular function using two-dimensional echocardiography. Am Heart J 107(3):526–531CrossRef

17.

Bruch C, Grude M, Muller J, Breithardt G, Wichter T (2005) Usefulness of tissue Doppler imaging for estimation of left ventricular filling pressures in patients with systolic and diastolic heart failure. Am J Cardiol 95(7):892–895. https://doi.org/10.1016/j.amjcard.2004.12.017 CrossRefPubMed

18.

Ng AC, da Tran T, Newman M, Allman C, Vidaic J, Lo ST, Hopkins AP, Leung DY (2008) Left ventricular longitudinal and radial synchrony and their determinants in healthy subjects. J Am Soc Echocardiogr 21(9):1042–1048. https://doi.org/10.1016/j.echo.2008.05.002 CrossRefPubMed

19.

Klitsie LM, Roest AA, van der Hulst AE, Stijnen T, Blom NA, Ten Harkel AD (2013) Assessment of intraventricular time differences in healthy children using two-dimensional speckle-tracking echocardiography. J Am Soc Echocardiogr 26(6):629–639. https://doi.org/10.1016/j.echo.2013.03.006 CrossRefPubMed

20.

Perk G, Tunick PA, Kronzon I (2007) Non-Doppler two-dimensional strain imaging by echocardiography–from technical considerations to clinical applications. J Am Soc Echocardiogr 20(3):234–243. https://doi.org/10.1016/j.echo.2006.08.023 CrossRefPubMed

21.

Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28(1):1–39. https://doi.org/10.1016/j.echo.2014.10.003 CrossRefPubMed

22.

Dittoe N, Stultz D, Schwartz BP, Hahn HS (2007) Quantitative left ventricular systolic function: from chamber to myocardium. Crit Care Med 35(8):S330–339. https://doi.org/10.1097/01.CCM.0000270245.70103.7E CrossRefPubMed

23.

Daneshvar D, Wei J, Tolstrup K, Thomson LE, Shufelt C, Merz CN (2010) Diastolic dysfunction: improved understanding using emerging imaging techniques. Am Heart J 160(3):394–404. https://doi.org/10.1016/j.ahj.2010.06.040 CrossRefPubMed

24.

Dragulescu A, Friedberg MK (2014) A tale of two ventricles: ventricular-ventricular interactions and LV dysfunction after surgical repair of Tetralogy of Fallot. Eur Heart J Cardiovasc Imaging 15(5):498–499. https://doi.org/10.1093/ehjci/jet260 CrossRefPubMed

25.

Ait Ali L, Trocchio G, Crepaz R, Stuefer J, Stagnaro N, Siciliano V, Molinaro S, Sicari R, Festa P (2016) Left ventricular dysfunction in repaired tetralogy of Fallot: incidence and impact on atrial arrhythmias at long term-follow up. Int J Cardiovasc Imaging 32(9):1441–1449. https://doi.org/10.1007/s10554-016-0928-7 CrossRefPubMed

26.

Roche SL, Grosse-Wortmann L, Friedberg MK, Redington AN, Stephens D, Kantor PF (2015) Exercise echocardiography demonstrates biventricular systolic dysfunction and reveals decreased left ventricular contractile reserve in children after tetralogy of Fallot repair. J Am Soc Echocardiogr 28(3):294–301. https://doi.org/10.1016/j.echo.2014.10.008 CrossRefPubMed

27.

Moon TJ, Choueiter N, Geva T, Valente AM, Gauvreau K, Harrild DM (2015) Relation of biventricular strain and dyssynchrony in repaired tetralogy of fallot measured by cardiac magnetic resonance to death and sustained ventricular tachycardia. Am J Cardiol 115(5):676–680. https://doi.org/10.1016/j.amjcard.2014.12.024 CrossRefPubMed

28.

Silvilairat S, Wongsathikun J, Sittiwangkul R, Pongprot Y, Chattipakorn N (2011) Effects of left ventricular function on the exercise capacity in patients with repaired tetralogy of Fallot. Echocardiography 28(9):1019–1024. https://doi.org/10.1111/j.1540-8175.2011.01499.x CrossRefPubMed

29.

Cruz C, Pinho T, Sousa C, Dias CC, Silva Cardoso J, Maciel MJ (2018) Ascending aorta in tetralogy of Fallot: beyond echocardiographic dimensions. Echocardiography 35(9):1362–1369. https://doi.org/10.1111/echo.14046 CrossRefPubMed

30.

Krishna SN, Hasija S, Chauhan S, Kaushal B, Chowdhury UK, Bisoi AK, Khan MA (2019) Can echocardiographic right ventricular function parameters predict vasoactive support requirement after tetralogy of Fallot repair? J Cardiothorac Vasc Anesth. https://doi.org/10.1053/j.jvca.2019.01.036 CrossRefPubMed

31.

Mercer-Rosa L, Zhang X, Tanel RE, Rychik J, Fogel MA, Paridon SM, Goldmuntz E (2018) Perioperative factors influence the long-term outcomes of children and adolescents with repaired tetralogy of Fallot. Pediatr Cardiol 39(7):1433–1439. https://doi.org/10.1007/s00246-018-1913-9 CrossRefPubMedPubMedCentral

32.

Meluzin J, Spinarova L, Hude P, Krejci J, Dusek L, Vitovec J, Panovsky R (2005) Combined right ventricular systolic and diastolic dysfunction represents a strong determinant of poor prognosis in patients with symptomatic heart failure. Int J Cardiol 105(2):164–173. https://doi.org/10.1016/j.ijcard.2004.12.031 CrossRefPubMed

33.

Meluzin J, Spinarova L, Hude P, Krejci J, Kincl V, Panovsky R, Dusek L (2005) Prognostic importance of various echocardiographic right ventricular functional parameters in patients with symptomatic heart failure. J Am Soc Echocardiogr 18(5):435–444. https://doi.org/10.1016/j.echo.2005.02.004 CrossRefPubMed

34.

Martins IF, Doles IC, Bravo-Valenzuela NJM, Santos A, Varella MSP (2018) When is the best time for corrective surgery in patients with tetralogy of Fallot between 0 and 12 months of age? Braz J Cardiovasc Surg 33(5):505–510. https://doi.org/10.21470/1678-9741-2018-0019 CrossRefPubMedPubMedCentral

Title: Left and Right Ventricular Impairment Shortly After Correction of Tetralogy of Fallot
Authors: Covadonga Terol
Vivian P. Kamphuis
Mark G. Hazekamp
Nico A. Blom
Arend D. J. Ten Harkel
Publication date: 01-06-2020
Publisher: Springer US
Keywords: Echocardiography
Echocardiography
Tetralogy of Fallot
Tetralogy of Fallot
Published in: Pediatric Cardiology / Issue 5/2020
Print ISSN: 0172-0643
Electronic ISSN: 1432-1971
DOI: https://doi.org/10.1007/s00246-020-02355-6

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