Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jun;41(5):1042-1050.
doi: 10.1007/s00246-020-02355-6. Epub 2020 May 4.

Left and Right Ventricular Impairment Shortly After Correction of Tetralogy of Fallot

Covadonga Terol  1 , Vivian P Kamphuis  1   2 , Mark G Hazekamp  3 , Nico A Blom  1   4 , Arend D J Ten Harkel  5
Affiliations

Left and Right Ventricular Impairment Shortly After Correction of Tetralogy of Fallot

Covadonga Terol et al. Pediatr Cardiol. 2020 Jun.

Abstract

Surgical repair of Tetralogy of Fallot (ToF) is usually performed in the first months of life with low early postoperative mortality. During long-term follow-up, however, both right (RV) and left ventricular (LV) performances may deteriorate. Tissue Doppler imaging (TDI) and speckle tracking echocardiography (ST) can unmask a diminished RV and LV performance. The objective of the current study was to assess the cardiac performance before and shortly after corrective surgery in ToF patients using conventional, TDI and ST echocardiographic techniques. Thirty-six ToF patients after surgery were included. Transthoracic echocardiography including TDI and ST techniques was performed preoperatively and at hospital discharge after surgery (10 days to 4 weeks after surgery). Median age at surgery was 7.5 months [5.5-10.9]. Regarding the LV systolic function there was a significant decrease in interventricular septum (IVS) S' at discharge as compared to preoperatively (pre IVS S' = 5.4 ± 1.4; post IVS S' = 3.9 ± 1.2; p < 0.001) and in global longitudinal peak strain (GLS) (pre = - 18.3 ± 3.4; post = - 14.2 ± 4.1; p = 0.003); but not in the fractional shortening (FS). Both conventional and TDI parameters showed a decrease in diastolic function at discharge. Tricuspid Annular Plane Systolic Excursion and RV S' were significantly lower before discharge. When assessing the RV diastolic performance, only the TDI demonstrated a RV impairment. There was a negative correlation between age at surgery and postoperative LV GLS (R = - 0.41, p = 0.031). There seems to be an impairment in left and right ventricle performance at discharge after ToF corrective surgery compared to preoperatively. This is better determined with TDI and ST strain imaging than with conventional echocardiography.

Keywords: Cardiac surgery; Color doppler tissue imaging; Doppler tissue imaging; Strain; Tetralogy of fallot; Tissue and strain doppler echocardiography.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Longitudinal strain of a male patient with Tetralogy of Fallot: a before surgery (GLS − 17.1%) and b before discharge after surgery (GLS − 10.8%). GLS global longitudinal peak strain
See this image and copyright information in PMC

References

    1. Jacobs JP, Mayer JE, Jr, Pasquali SK, Hill KD, Overman DM, St Louis JD, Kumar SR, Backer CL, Fraser CD, Tweddell JS, Jacobs ML. The society of thoracic surgeons congenital heart surgery database: 2018 update on outcomes and quality. Ann Thorac Surg. 2018 doi: 10.1016/j.athoracsur.2018.01.001. - DOI - PubMed
    1. Villafane J, Feinstein JA, Jenkins KJ, Vincent RN, Walsh EP, Dubin AM, Geva T, Towbin JA, Cohen MS, Fraser C, Dearani J, Rosenthal D, Kaufman B, Graham TP, Jr, Adult C, Pediatric Cardiology Section ACoC Hot topics in tetralogy of Fallot. J Am Coll Cardiol. 2013;62(23):2155–2166. doi: 10.1016/j.jacc.2013.07.100. - DOI - PubMed
    1. Broberg CS, Aboulhosn J, Mongeon FP, Kay J, Valente AM, Khairy P, Earing MG, Opotowsky AR, Lui G, Gersony DR, Cook S, Ting JG, Webb G, Gurvitz MZ, Alliance for Adult Research in Congenital C Prevalence of left ventricular systolic dysfunction in adults with repaired tetralogy of fallot. Am J Cardiol. 2011;107(8):1215–1220. doi: 10.1016/j.amjcard.2010.12.026. - DOI - PubMed
    1. de Boer JM, Kuipers IM, Klitsie LM, Blom NA, Ten Harkel AD. Decreased biventricular longitudinal strain shortly after congenital heart defect surgery. Echocardiography. 2017;34(3):446–452. doi: 10.1111/echo.13456. - DOI - PubMed
    1. Klitsie LM, Hazekamp MG, Roest AA, Van der Hulst AE, Gesink-van der Veer BJ, Kuipers IM, Blom NA, Ten Harkel AD. Tissue Doppler imaging detects impaired biventricular performance shortly after congenital heart defect surgery. Pediatr Cardiol. 2013;34(3):630–638. doi: 10.1007/s00246-012-0513-3. - DOI - PubMed

MeSH terms