on July 30, 2008
Published online before print July 30, 2008, doi: 10.1161/CIRCIMAGING.108.783795
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Original Article |
Functional Analysis of the Components of the Right Ventricle in the Setting of Tetralogy of Fallot.
1 Deutsches Herzzentrum, Germany;
2 Division of Imaging Sciences, King's College London, United Kingdom;
3 Department of Heart- Thorax- and Transplantation Medicine, Medical University Hannover, Germany;
4 Institute of Biostatistics, University of Magdeburg, Germany;
5 Dept. of Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum Berlin, Germany;
6 Institute of Child Health, University College London, United Kingdom
7 E-mail: kuehne{at}dhzb.de
Background—Anatomic and functional observations suggest that the right ventricle (RV) can be analysed in terms of its inlet, apical trabecular, and outlet components. Our This study was designed to evaluate the regional adaptation of these components to different conditions of loadingRV overload, with additional analysis of the and surgical techniques used for employed during primary repair.
Methods and Results—We studied prospectively 45 patients with tetralogy of Fallot, and 24 control subjects, that aged 20.5±8.1 and 20.1±5.8 years, respectively. All subjects were studied by cardiac MRI. End-diastolic (EDV), end-systolic (ESV), stroke volumes (SV) and ejection fraction (EF) were determined for the overall RV, and separately for its inlet, apical trabecular, and outlet components. The patients had pulmonary regurgitant fractions of 33.2±11.1%, and RV peak-systolic pressures of 40.7±16.1 mmHg. In controls, the apical trabecular component EDV was 51.5±11.1 ml/m2 (54.3±6.8% of the total RV EDV), ESV was 19.2±6.3 ml/m2 (47.6±10.5% of RV ESV), and stroke volume was 32.3±6.9 ml/m2 (58.9±6.6% of RV SV), resulting in an EF of 63.1±7.7%. When considering all patients, the apical trabecular component took up the greatest part of the overload, having an EDV of 76.5±18.1 ml/m2, and an ESV of 31.6±12.8 ml/m2, reflecting an increase of 49% and 67% over controls, respectively (p<0.001). EF was 59.7±10.7%, and was maintained at control levels (p=0.132). In controls, the outlet had considerable ejecting force. with an EF of 54.8±9.1%, whereas it was decreased in the patients with tetralogy the outlet was dyskinetic (EF=28.5±11.9%). There was significant increase of ESV (p<0.001), but not of EDV, with EF decreased by 45% (p<0.001). The inlet was not significantly affected by overload. The surgical technique did not affect significantly any measured parameter for any component.
Conclusions—In patients with tetralogy of Fallot, subsequent to surgical correction, the individual components of the RV respond in characteristic fashion to RV overload.
Key Words: magnetic resonance imaging • tetralogy of Fallot • cardiac MRI • congenital heart disease • RV function
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