ABSTRACT
BACKGROUND: Reliable, non-invasive evaluation of right ventricular function, especially in congenital heart disease, is challenging. OBJECTIVES: The aim of this study was to evaluate Doppler tissue imaging (DTI) parameters of lateral tricuspid annular motion, mean rate of pressure rise during RV contraction (mean dP/dt) and indexed right ventricular (RV) stroke volume (RVSVi) as RV function indices in repaired tetralogy of Fallot (TOF). METHODS: DTI evaluation was performed in 25 repaired-TOF patients, aged 11+/-6, at rest and during dobutamine infusion and 20 controls at rest. RESULTS: TOF patients had lower (P<0.05) peak systolic velocity (Sa) (11.4+/-4 vs. 13.7+/-3.1 cm/s), early diastolic velocity (Ea) (11+/-3.1 vs. 16.3+/-3.5 cm/s) and Sa/time from onset of QRS to Sa (Sa/Q-Sa) (68.8+/-26.4 vs. 92.3+/-29.4 cm/s2) versus controls. Dobutamine increased (P<0.01) Sa (11.4+/-2.8-17.7+/-4.7 cm/s), Ea (11+/-3.1-15.6+/-3.9 cm/s), late diastolic velocity (Aa) (8.4+/-2-14.8+/-5 cm/s), Sa/Q-Sa (68.8+/-26.4-17 6.8+/-84.5 cm/s2), mean dP/dt (180+/-74-537+/-37 2 mmHg/s), and RVSVi (7.8+/-3.9-11.9+/-5.6 L/min/m2). RVSVi increase correlated (P<0.01) with that in Sa (r=0.6), Ea (r=0.5), Sa/Q-Sa (r=0.71), and mean dP/dt (r=0.57) while mean dP/dt increase correlated strongly with Sa/Q-Sa increase (r=0.88). CONCLUSION: DTI evaluation of tricuspid annular motion during dobutamine infusion in repaired TOF correlates with dP/dt and RV stroke volume and may help in assessing RV function and reserve.
Subject(s)
Echocardiography, Stress , Tetralogy of Fallot/physiopathology , Tetralogy of Fallot/surgery , Tricuspid Valve/diagnostic imaging , Tricuspid Valve/physiopathology , Ventricular Function, Right/physiology , Adolescent , Blood Flow Velocity/physiology , Blood Pressure/physiology , Case-Control Studies , Child , Female , Humans , Male , Pulmonary Valve Insufficiency/diagnostic imaging , Pulmonary Valve Insufficiency/physiopathology , Rest/physiology , Stroke Volume/physiology , Tricuspid Valve Insufficiency/diagnostic imaging , Tricuspid Valve Insufficiency/physiopathology , Ultrasonography, Doppler, PulsedABSTRACT
BACKGROUND: Definition of normative data of the great arteries from neonatal to adult ages may aid in assessment of the growth of cardiovascular structures, thus guiding the timing and type of intervention in patients with congenital cardiac disease. METHODS: We calculated the cross-sectional areas of the arterial roots at the basal attachment of the valvar leaflets, the sinuses, and standardized distal sites using cineangiograms of 59 normal children and adolescents with mean age of 5.4 plus or minus 4.7 years and a range from 0.1 to 16 years, the children having a mean weight of 21.2 plus or minus 15.7 kilograms, with a range from 2.2 to 68 kilograms, and mean height of 108 plus or minus 35 centimetres, with a range from 43 to 184 centimetres. Values at each site were calculated averaging end-diastolic and end-systolic measurements, and indexed to body surface area. Results are expressed as the mean plus or minus the standard deviation. RESULTS: The diameter of the aortic root at the basal attachment of the leaflets was 249 plus or minus 26, the midpoint of the sinuses 379 plus or minus 59, the sinutubular junction 290 plus or minus 58, the isthmus 158 plus or minus 36, the postisthmic region 152 plus or minus 33, and the descending aorta at the level of diaphragm 130 plus or minus 18 millimetres squared per metre squared. The pulmonary root measured at the basal attachment of the leaflets was 253 plus or minus 28, the midpoint of the sinuses 352 plus or minus 58, the sinutubular junction 293 plus or minus 58, the right pulmonary artery 176 plus or minus 25, the left pulmonary artery 153 plus or minus 20, and sum of right and left pulmonary arteries 330 plus or minus 37 millimetres squared per metre squared. All indexes were consistent over a wide range for body surface areas. CONCLUSIONS: Definition of normative data of the great vessels may aid in the evaluation of congenital or acquired abnormalities, serving as guidelines for intervention during medical or surgical management and follow-up.
Subject(s)
Angiography , Aorta, Thoracic/anatomy & histology , Aorta, Thoracic/diagnostic imaging , Aortography , Pulmonary Artery/anatomy & histology , Pulmonary Artery/diagnostic imaging , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Reference ValuesABSTRACT
Apart from closure of atrial septal defects, there is little information concerning the use of the CardioSEAL family of occluders in congenitally malformed hearts. We review here our initial experience using the CardioSEAL and STARFlex occluders in 12 patients aged 17.3 +/- 11.2 years, with a range from 4 to 34 years. Of the patients, 5 had fenestrated extracardiac Fontan procedures, 5 had persistent patency of the arterial duct, 1 had a leak across a Mustard baffle, and the final patient had a huge pulmonary arteriovenous malformation. We implanted successfully 9 CardioSEAL, and 3 STARFlex occluders, with sizes from 17 to 40 mm. In one patient, the occluder embolized to the right pulmonary artery, from where it was retrieved through the catheter. In two patients, there was a trivial residual leak immediately after implantation, but no patient had a residual leak after 6 months of follow-up. We noted improved ventricular dimensions, without any fractures of the arms of the occluders, perforations, or disturbances of flow after 2.4 +/- 0.9 years of follow-up. We have demonstrated, therefore, the versatility of the CardioSEAL and STARFlex occluders, which have been used safely and effectively to close a variety of intra and extracardiac communications other than atrial septal defects.