Morphologic change of pulmonary arteries and right ventricular outflow tract after total correction of tetralogy of Fallot: risk factors for pulmonary artery junctional stenosis

BACKGROUND AND OBJECTIVES: Recently, the result of total correction in tetralogy of Fallot(TOF) is improved dramatically. But, residual anatomical changes of right ventricular outflow tract(RVOT) and pulmonary artery junctional stenosis result in bad prognosis. Therefore we sought to analyze risk factors for pulmonary artery junctional stenosis after correction of TOF. METHODS: From 1991 to 1998, 146 patients underwent the follow-up catheterizations after total correction of TOF in our institution and were analysed risk factors for pulmonary artery junctional stenosis. Of this patients group [age on operation 20.119.8 months, follow-up duration after operation 13.95.0 months, male(64%)], 20 cases(13.7%) had a PDA and 26 cases(17.8%) had a systemic-to-pulmonary shunt operation before total correction of TOF. RESULTS: 1) Residual PS is correlated significantly with post-operative RVP/LVP(r=.776, p<0.01) and post-operative RVEDP(r=.196, p<0.05). 2) Post-operative RVP/LVP and residual PS increased significantly in grade II of residual PI than grade III~IV. 3) The left pulmonary artery junctional stenosis(LPAJS) was observed in 31 cases, this group decreased significantly in pre-operative LPA diameter(p<0.01), increased in post-operative RVP/LVP(p<0.01), and increased in post-operative RPA diameter(p<0.01), decreased in post-operative LPA diameter(p<0.01) and was more severe in post-operative PI(p<0.01) than the other group respectively. 4) Of the patients group which went patch enlargement of RVOT to LPA junction, the pressure gradient on LPA junction increased significantly in PDA and false aneurysmal change. 5) Factors significantly associated with pulmonary artery junctional stenosis were patch enlargement of RVOT to LPA junction, aneurysmal change of RVOT, PDA, systemic-to-pulmonary shunt and pre-operative LPAJS. 6) LPAJS(P, mmHg) =5.43 +16.24*[false aneurysmal change of RVOT] +14.13*[RVOT patch enlargement to LPA] +16.89*PDA. CONCLUSION: Several factors significantly associated with pulmonary artery junctional stenosis influenced each other. And the LPAJS led to secondary changes (volume overload of RV, increasing diameter of RPA, et. al) therefore more active diagnosis and treatment after total correction is recommended.

Left ventricular function after mitral valve operation in congenital mitral regurgitation

BACKGROUND: Severe mitral regurgitation is a common clinical entity that can lead to progressive, irreversible left ventricular dysfunction, and thus should be corrected in proper stage of life. Authors have conducted this investigation to assess left ventricular function after mitral valve operation and to determine the predicting factors. METHODS AND RESULTS: The echocardiographic parameters, specifically left ventricular ejection fraction, shortening fraction, end-systolic dimension and volume, and end-diastolic dimension and volume were measured in preoperative and postoperative period of congenital mitral regurgitation patients (n=60), between March 1992 and March 1998. After correction of severe mitral regurgitaion, left ventricular ejection fraction and shortening fraction decreased significantly (p<0.001 and p<0.05 respectively). Furtheremore, after reoperation of recurred mitral regurgitation, left ventricular ejection fraction and shortening fraction decreased significantly (p<0.05). Left ventricular ejection fraction and shortening fraction in mitral valve reoperation group (n=23) is significantly lower than those in non-reoperation group (n=37) in both preoperative and postoperative period (p<0.05). Left ventricular ejection fraction and shortening fraction is also significantly lower in mitral valve replacement group (n=20) than in mitral valvuloplasty group (n=40)(p<0.05). Severe postoperative left ventricular dysfunction led to dilated cardiomyopathy in 5 patients. Postoperative left ventricular end systolic dimension increased significantly in reoperation group and DCMP group respectively (p<0.05). CONCLUSION: After surgical correction of mitral regurgitation, left ventricular dysfunction is frequent and carries a poor prognosis. Postoperative left ventricular dysfunction can be predicted by preoperative ejection fraction, shortening fraction and systolic diameter. Therefore surgical therapy before the onset of left ventricular dysfunction is recommended.