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Journal of Cardiothoracic Surgery

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Open Access 01-12-2020 | Pulmonary Valve Replacement | Research article

Evaluation of right ventricle pulmonary artery coupling on right ventricular function in post operative tetralogy of Fallot patients underwent for pulmonary valve replacement

Authors: Bhushan Sandeep, Xin Huang, Yuan Li, Xiaowei Wang, Long Mao, Yue Kan, Dan Xiong, Ke Gao, Xiao Zongwei

Published in: Journal of Cardiothoracic Surgery | Issue 1/2020

Abstract

Background

To evaluate RV-PA coupling in post operative TOF patients with ventricular dilatation underwent for PVR and investigate the correlation between ventricular functions measuring Ea/Emax ratio using cardio magnetic resonance and the effect of surgical type at primary repair of TOF on coupling.

Method

RV-PA coupling was measured noninvasively by Ea/Emax ratio from CMRI and ECHO. From CMRI results the patients were divided in two groups, RV-PA coupling and RV-PA uncoupling. Ea/Emax ≤1 was considered for coupling patients and Ea/Emax > 1 for uncoupling patients.

Results

Ninety patients were uncoupled (Ea/Emax: 1.55 ± 0.46) and 45 were coupled (Ea/Emax: 0.81 ± 0.15). Out of 75 TAP repaired patients 60 were uncoupled RV-PV. In addition, higher pro-BNP is an important factor for uncoupled RV-PV (P = 0.001). CMR evaluation for right ventricular function between uncoupling and coupling were RVEDVi (196.65 ± 63.57 vs. 154.28 ± 50.07, P = 0.001), RVESVi (121.19 ± 51.47 vs. 83.94 ± 20.43, P = 0.001), RVSVi (67.19 ± 19.87 vs. 106.31 ± 33.44, P = 0.001), and RVEF (40.90 ± 8.73 vs. 54.63 ± 4.76, P = 0.001). The increased RVEDVi, RVESVi and RVSVi and decreased RVEF have significant correlation with Ea/Emax. Ea/Emax was also found positively correlated with RVEDVi (P = < 0.05, r = 0.35), RVESVi (P = < 0.001, r = 0.41) and negatively correlated with RVSVi (P = < 0.05, r = 0.22) and RVEF (P = < 0.05, r = 0.78).

Conclusions

Unfavorable RV-PA coupling is present in post operative TOF patients and it is affected by several factors. Our results explain a new concept of RV-PA interactions as a contributing mechanism for the observed decline in RV function.

Bhushan S, Xin H, Fan X, Pengxiao S, Ting W, Xiaoke S. Etiology of right ventricular restrictive physiology early after repair of tetralogy of Fallot in pediatric patients. J Cardiothorac Surg. 2019;14:84. https://doi.org/10.1186/s13019-019-0909-8.CrossRef

Bustamante-Labarta M, Perrone S, Leon DLFR, Stutzbach P, Perez DLHR. Right atrial size and tricuspid regurgitation severity predict mortality or transplantation in primary pulmonary hypertension. J Am Soc Echocardiog. 2002;15(10):1160–4. https://doi.org/10.1067/mje.2002.123962.CrossRef

Benza R, Foreman AJ, Gombergmaitland M, Frantz R. Predicting survival in pulmonary arterial hypertension using the reveal database. Circulation. 2010;122:164–72. https://doi.org/10.1161/CIRCULATIONAHA.109.898122.CrossRefPubMed

Bove T, Bouchez S, Hert SD, Wouters P. Acute and chronic effects of dysfunction of right ventricular outflow tract components on right ventricular performance in a porcine model. J Am Coll Cardiol. 2012;60:64–71. https://doi.org/10.1016/j.jacc.2012.03.035.CrossRefPubMed

Champion HC, Michelakis ED, Hassoun PM. Comprehensive invasive and noninvasive approach to the right ventricle in pulmonary circulation unit. J Cell Physiol. 2009;226:2198–205. https://doi.org/10.1161/CIRCULATIONAHA.106.674028.CrossRef

François CJ, Srinivasan S, Schiebler ML, Reeder SB. 4d cardiovascular magnetic resonance velocity mapping of alterations of right heart flow patterns and main pulmonary artery hemodynamics in tetralogy of fallot. J Cardiov Magn Reson. 2012;14:16. https://doi.org/10.1186/1532-429X-14-16.CrossRef

Bédard E, Mccarthy KP, Dimopoulos K, Giannakoulas G. Structural abnormalities of the pulmonary trunk in tetralogy of fallot and potential clinical implications: a morphological study. J Am Coll Cardiol. 2009;54:1883–90. https://doi.org/10.1016/j.jacc.2009.06.040.CrossRefPubMed

Eyskens B, Reybrouck T, Bogaert J, Dymarkowsky S, Gewillig M. Homograft insertion for pulmonary regurgitation after repair of tetralogy of fallot improves cardiorespiratory exercise performance. Am J Cardiol. 2000;85:221–5. https://doi.org/10.1016/S0002-9149(99)00640-2.CrossRefPubMed

Forfia PR, Fisher MR, Mathai SC, Housten-Harris T, Hemnes AR. Tricuspid annular displacement predicts survival in pulmonary hypertension. Am J Resp Crit Care. 2006;174:1034–41. https://doi.org/10.1164/rccm.200604-547OC.CrossRef

10.

Fourie PR, Coetzee AR, Bolliger CT. Pulmonary artery compliance: its role in right ventricular-arterial coupling. Cardiovasc Res. 1992;26:839–44. https://doi.org/10.1093/cvr/26.9.839.CrossRefPubMed

11.

Geva T. Repaired tetralogy of fallot:the roles of cardiovascular magnetic resonance in evaluating pathophysiology and for pulmonary valve replacement decision support. J Cardio Magn Reson. 2011:13. https://doi.org/10.1186/1532-429X-139.

12.

Gatzoulis M. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of fallot: a multicentre study. Lancet. 2000;356. https://doi.org/10.1016/S0140-6736(00)02714-8.

13.

Hoeper MM, Bogaard HJ, Condliffe R, Frantz R. Definitions and diagnosis of pulmonary hypertension. J Am Coll Cardiol. 2013;62:D42–50. https://doi.org/10.1016/j.jacc.2013.10.032.CrossRefPubMed

14.

Kelly RP, Ting CT, Yang TM, Liu CP, Kass DA. Effective arterial elastance as index of arterial vascular load in humans. Circulation. 1992;86:513–21. https://doi.org/10.1161/01.CIR.86.2.513.CrossRefPubMed

15.

Kilner PJ, Balossino R, Dubini G, Babu-Narayan SV, Taylor AM. (2009). Pulmonary regurgitation: the effects of varying pulmonary artery compliance, and of increased resistance proximal or distal to the compliance. Int J Cardiol, 133:0–166. doi:https://doi.org/10.1016/j.ijcard.2008.06.078.

16.

Kuehne T, Yilmaz S, Steendijk P. Magnetic resonance imaging analysis of right ventricular pressure-volume loops: in vivo validation and clinical application in patients with pulmonary hypertension. Circulation. 2004;110:2010–6. https://doi.org/10.1161/01.CIR.0000143138.02493.DD.CrossRefPubMed

17.

Naeije R, D"Alto M, Forfia PR. Clinical and research measurement techniques of the pulmonary circulation: the present and the future. Prog Cardiovasc Dis. 2015;57:463–72. https://doi.org/10.1016/j.pcad.2014.12.003.CrossRefPubMed

18.

Olschewski H, Hoeper MM, Borst MM, Ewert R, Worth H. Diagnosis and therapy of chronic pulmonary hypertension. Clin Res Cardiol. 2007;96:301–30. https://doi.org/10.1055/s-2006-954981.CrossRefPubMed

19.

Piene H. Pulmonary arterial impedance and right ventricular function. Physiol Rev. 1986;66:606–52. https://doi.org/10.1152/physrev.1986.66.3.606.CrossRefPubMed

20.

Rebergen SA, Chin JG, Ottenkamp J, WEE V d. Pulmonary regurgitation in the late postoperative follow-up of tetralogy of fallot. Volumetric quantitation by nuclear magnetic resonance velocity mapping. Circulation. 1993;85:2257–66. https://doi.org/10.1161/01.CIR.88.5.2257.CrossRef

21.

Therrien J, Siu SC, Mclaughlin PR, Liu PP, Webb GD. Pulmonary valve replacement in adults late after repair of tetralogy of fallot: are we operating too late? J Am Coll Cardiol. 2000;36:1670–5. https://doi.org/10.1016/S0735-1097(00)00930-X.CrossRefPubMed

Title: Evaluation of right ventricle pulmonary artery coupling on right ventricular function in post operative tetralogy of Fallot patients underwent for pulmonary valve replacement
Authors: Bhushan Sandeep
Xin Huang
Yuan Li
Xiaowei Wang
Long Mao
Yue Kan
Dan Xiong
Ke Gao
Xiao Zongwei
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Pulmonary Valve Replacement
Pulmonary Valve Replacement
Magnetic Resonance Imaging
Magnetic Resonance Imaging
Pulmonary Valve Replacement
Tetralogy of Fallot
Tetralogy of Fallot
Published in: Journal of Cardiothoracic Surgery / Issue 1/2020
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-020-01281-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Evaluation of right ventricle pulmonary artery coupling on right ventricular function in post operative tetralogy of Fallot patients underwent for pulmonary valve replacement

Abstract

Background

Method

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusions

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