Investigation of right ventricle function in patients with tetralogy of Fallot after total correction using cardiac magnetic resonance imaging / 영남의대학술지

BACKGROUND: We investigated the difference in right ventricle (RV) volume and ejection fraction (EF) according to the pulmonary valve (PV) annular extension technique during Tetralogy of Fallot (TOF) total correction. METHODS: We divided patients who underwent the procedure from 1993 to 2003 into two groups according to PV extension technique (group I: PV annular extension, group II: no PV annular extension) during TOF total correction. We then analyzed the three segmental (RV inlet, trabecular and outlet) and whole RV volume and EF by cardiac magnetic resonance imaging (MRI). RESULTS: Fourteen patients were included in this study (group I: 10 patients, group II: four patients; male: nine patients, female: five patients). Cardiac MRI was conducted after a 16.1 years TOF total correction follow-up period. There was no statistical difference in RV segmental volume index or EF between groups (all p>0.05). Moreover, the total RV volume index and EF did not differ significantly between groups (all p>0.05). CONCLUSION: The RV volume and EF of the PV annular extension group did not differ from that of the PV annular extension group. Thus, PV annular preservation technique did not show the surgical advantage compared to PV annular extension technique in this study.

Investigation of right ventricle function in patients with tetralogy of Fallot after total correction using cardiac magnetic resonance imaging / 영남의대학술지

BACKGROUND: We investigated the difference in right ventricle (RV) volume and ejection fraction (EF) according to the pulmonary valve (PV) annular extension technique during Tetralogy of Fallot (TOF) total correction.METHODS: We divided patients who underwent the procedure from 1993 to 2003 into two groups according to PV extension technique (group I: PV annular extension, group II: no PV annular extension) during TOF total correction. We then analyzed the three segmental (RV inlet, trabecular and outlet) and whole RV volume and EF by cardiac magnetic resonance imaging (MRI).RESULTS: Fourteen patients were included in this study (group I: 10 patients, group II: four patients; male: nine patients, female: five patients). Cardiac MRI was conducted after a 16.1 years TOF total correction follow-up period. There was no statistical difference in RV segmental volume index or EF between groups (all p>0.05). Moreover, the total RV volume index and EF did not differ significantly between groups (all p>0.05).CONCLUSION: The RV volume and EF of the PV annular extension group did not differ from that of the PV annular extension group. Thus, PV annular preservation technique did not show the surgical advantage compared to PV annular extension technique in this study.

Localización del electrodo de marcapasos definitivo en el tracto de salida del ventrículo derecho mediante tomografía axial computarizada / Determinating the location of the permanent pacemaker lead in the right ventricle outflow tract by computed tomography

Introducción: Precisar la ubicación del electrodo de marcapasos en el tracto de salida del ventrículo derecho (TSVD) es difícil mediante las técnicas convencionales (fluoroscopia y electrocardiografía). La tomografía permite determinar de forma tridimensional la relación del electrodo en el TSVD. Objetivo: Determinar la localización del electrodo de marcapasos mediante la tomografía axial computarizada y comparar los resultados con la localización electrocardiográfica y fluoroscópica. Material y métodos: Se incluyeron 36 pacientes portadores de marcapasos definitivo VVI con el electrodo localizado en el TSVD, a quienes se les tomó un electrocardiograma de 12 derivaciones, proyecciones fluoroscópicas convencionales y tomografía multicorte para determinar la posición del electrodo en el TSVD. Resultados: Mediante el electrocardiograma se localizó el electrodo septal en 58.3% y en pared libre en 41.7%. Por fluoroscopia en oblicua anterior izquierda (OAI) a 35° se localizó el electrodo en pared anterior 5.6%, en pared libre en 38.9% y septal en 55.6%; en OAI a 45° en pared anterior en 2.8%, en pared libre 44.4% y septal en 52.8%. Mediante tomografía se documentó la posición anterior del electrodo en 39%, pared libre en 48% y septal en 13%. El coeficiente Kappa de las 3 pruebas mostró una concordancia muy baja. Conclusión: La tomografía es un mejor método para determinar la posición del electrodo en TSVD comparado contra la fluoroscopia y el electrocardiograma.

Introduction: Determination of the location of the lead of the permanent pacemaker in the right ventricle outflow tract (RVOT) it's difficult with the conventional techniques (fluoroscopic images and electrocardiography). The computed tomography (CT) allows to determinate in three dimensions the relation between the lead and the RVOT. Objective: Determine the location of the electrode lead by computed tomography and compare the results with electrocardiographic and fluoroscopy images localization. Material and methods: 36 patients were included with VVI permanent pacemaker with the lead in the RVOT. A 12-lead electrocardiogram, fluoroscopy images and CT were performed to determine the position of the lead in the RVOT. Results: By electrocardiogram, we located the lead in septal wall 58.3% and free wall 41.7%. By fluoroscopy images in left anterior oblique (LAO) 35° the lead was located on the anterior wall 5.6%, free wall 38.9% and septal 55.6%; in LAO 45° anterior wall 2.8%, free wall 44.4% and septal 52.8%. By Tomography the lead was positioned on anterior wall in 39%, free wall 48% and septal 13%. The Kappa coefficient of the 3 tests showed very low concordance. Conclusion: CT is a better method for determining the position of the lead on the RVOT compared to fluoroscopy images an electrocardiogram.

Reconstruction of right ventricular outflow tract with BalMedic pulmonary valved conduit / 中华胸心血管外科杂志

Objective To evaluate the reconstruction of right ventricle outflow tract (RVOT) with BalMedic pulmonary valved conduit in multiple medical center.Methods Since January 2007,50 patients age (4.90 ± 7.63) years (range 6 month to 39 years),weight (16.20 ± 13.69) kg (range 4.50 to 65.0 kg),had been corrected by reconstruction of RVOT.There were 22 patients with pulmonary atresia and ventricular septal defect (PA/VSD) ; 10 patients with corrected transposition of the great arteries and pulmonary stenosis (C-TGA/PS) ; 7 patients with truncus; 4 patients with double outlet of right ventricle and pulmonary stenosis (DORV/PS) ; 3 patients with tetralogy of Fallot (TOF) ; 2 patients with complete transposition of the great arteries and pulmonary stenosis (TGA/PS) ; and each 1 with aortic stenosis (AS) and pulmonary stenosis (PS).Fifty BalMedic pulmonary valved conduits were implanted between pulmonary and RVOT underwent cardiopulmonary bypass.There were different diameter of pulmonary valved conduit included 10 mm to 24 mm depend on the patients weight and pulmonary size.All patients were followed up after operation on 1 month,3-6 months and more than 12 months.Results There was no death.Three patients were lost followed up after 12 months and one late death.There were no pulmonary valve stenosis about 91.1％,moderate pulmonary regurgitation 16.0％,no RVOT obstruction 95.6％,no main pulmonary artery stenosis 80.0％,and no right and left pulmonary artery stenosis 73.0％.Conclusion These results demonstrated that the BalMedic pulmonary valved conduit is reliable and effective in surgical procedure,but the long-term results should be followed up continually.

Clinical application of pulmonary artery valvuloplasty with repaired tetralogy of fallot / 中国综合临床

Objective To discuss clinic effect of pulmonary artery valvuloplasty for right ventricle outflow tract (RVOT) reconstruction in patients with repaired tetralogy of fallot (TOF). Methods A total of 93 cases TOF were randomly divided into Group A (n = 49) or Group B (n = 44) to perform the procedure with repaired tetralogy of fallot Group A received autogenous pericardium to enlarge RVOT and pulmonary valvuloplasty.Group B received autogenous pericardium to enlarge RVOT by routine therapy. Pulmonary regurgitation index (PRi) and the ratio between pulmonary regurgitant jet width and pulmonary annulus diameter were measured with echoeardiography. Results The mean follow-up was 3. 1 ± 0. 2 years. The PRi and the ratio between pulmonary regurgitant jet width and pulmonary annulus diameter in Group A were-significantly lower than Group B (0. 55 ± 0. 13 vs. 0. 61 ± 0. 10, t = 2. 685, P < 0.01) and ([52.0 ± 10.4] % vs. [57.1 ± 10. 5]% ,t = 2. 349, P < 0.05) . Three-dimensional ultrasound examination showed that 69% (34/69) of pulmonary valves in Group A was developed well. Conclusion Pulmonary valvuloplasty during transannular patch for repaired TOF may prevent fre'e pulmonary regurgitation and can obtain good clinical outcome.