Murat SARGIN, Uğur FİLİZCAN, E. Ergin EREN, Erol KURÇ, Serap Aykut AKA, Nurşin Kaynarca KÜLCÜ, Bülent KETENCİ, Gökçen ORHAN

Right ventricle restriction following total correction of tetralogy of fallot

Background: Restricted right ventricle physiology is defined as antegrade pulmonary flow caused by compromised right ventricular compliance during late diastole. Methods: Thirty-four tetralogy of Fallot patients with total correction were included in our study. In all patients, we investigated right ventricular functional status, pulmonary valve regurgitation, antegrade diastolic pulmonary flow measurements echocardiographically as well as QRS durations electrocardiographically. We compared the statistical differences of QRS duration, pulmonary regurgitation and right ventricular dilatation between the restricted and unrestricted right ventricle group. Operation age, follow-up periods, transannular patch utilizations, postoperative pharmacological posi¬tive inotropic agent need, and cross clamp periods were all analyzed. Results: There was no difference between the groups with and without antegrade diastolic pulmonary flow, in terms of follow-up period, age, transannular patch utilization, QRS duration and cross clamp period. There was a significant difference in terms of pulmonary regurgitation and right ventricular dilatation between the two groups. When the cases with and without pulmonary valve regurgitation were compared, there was no difference in terms of opera¬tive age, whereas significant difference was found in terms of QRS duration, right ventricular dilatation and transan¬nular patch utilization. Conclusion: In spite of its early negative effects, right ventricular restriction following total correction of tetralogy of Fallot may decrease morbidity by protecting from late complications. For this reason, it has been reported that cardiac performance is better preserved in restricted right ventricle physiology cases.

PDF

___

1. Norgård G, Gatzoulis MA, Josen M, Cullen S, Redington AN. Does restrictive right ventricular physiology in the early postoperative period predict subsequent right ventricular restriction after repair of tetralogy of Fallot? Heart 1998; 79:481-4.
2. Norgård G, Gatzoulis MA, Moraes F, Lincoln C, Shore DF, Shinebourne EA, et al. Relationship between type of outflow tract repair and postoperative right ventricular diastolic physiology in tetralogy of Fallot. Implications for long-term outcome. Circulation 1996;94:3276-80.
3. Gatzoulis MA, Clark AL, Cullen S, Newman CG, Redington AN. Right ventricular diastolic function 15 to 35 years after repair of tetralogy of Fallot. Restrictive physiology predicts superior exercise performance. Circulation 1995;91:1775-81.
4. Munkhammar P, Cullen S, Jögi P, de Leval M, Elliott M, Norgård G. Early age at repair prevents restrictive right ven tricular (RV) physiology after surgery for tetralogy of Fallot (TOF): diastolic RV function after TOF repair in infancy. J Am Coll Cardiol 1998;32:1083-7.
5. Kisanuki A, Tei C, Minagoe S, Otsuji Y, Natsugoe K, Kawazoe Y, et al. Diastolic pulmonary forward flow associ ated with pulmonary regurgitation demonstrated by Doppler echocardiography. J Cardiol 1987;17:361-72. [Abstract]
6. Gatzoulis MA, Till JA, Somerville J, Redington AN. Mechanoelectrical interaction in tetralogy of Fallot. QRS pro longation relates to right ventricular size and predicts malig nant ventricular arrhythmias and sudden death. Circulation 1995;92:231-7.
7. Cullen S, Shore D, Redington A. Characterization of right ventricular diastolic performance after complete repair of tetralogy of Fallot. Restrictive physiology predicts slow post operative recovery. Circulation 1995;91:1782-9.
8. Özkan S, Akay T, Gültekin B, Aslan A, Varan B, Tokel K ve ark. Fallot tetralojisinde sağ ventrikül çıkım yolu tamir yön temlerinin sağ ventrikül fonksiyonları üzerine etkisi. Türk Göğüs Kalp Damar Cer Derg 2005;13:340-5.
9. Meijboom F, Szatmari A, Deckers JW, Utens EM, Roelandt JR, Bos E, et al. Cardiac status and health-related quality of life in the long term after surgical repair of tetralogy of Fallot in infancy and childhood. J Thorac Cardiovasc Surg 1995;110(4 Pt 1):883-91.
10. Daliento L, Caneve F, Turrini P, Buja G, Nava A, Milanesi O, et al. Clinical significance of high-frequency, low-amplitude elec trocardiographic signals and QT dispersion in patients operated on for tetralogy of Fallot. Am J Cardiol 1995; 76:408-11.
11. Gatzoulis MA, Till JA, Redington AN. Depolarization repolarization inhomogeneity after repair of tetralogy of Fallot. The substrate for malignant ventricular tachycardia? Circulation 1997;95:401-4.
12. Chowdhury UK, Sathia S, Ray R, Singh R, Pradeep KK, Venugopal P. Histopathology of the right ventricular outflow tract and its relationship to clinical outcomes and arrhyth mias in patients with tetralogy of Fallot. J Thorac Cardiovasc Surg 2006;132:270-7.
13. Jonsson H, Ivert T, Brodin LA. Echocardiographic findings in 83 patients 13-26 years after intracardiac repair of tetral ogy of Fallot. Eur Heart J 1995;16:1255-63.