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. 2022 Jun;20(2):106-114.
doi: 10.1007/s12574-021-00558-1. Epub 2021 Nov 30.

Echocardiographic assessment of right ventricular volume in repaired tetralogy of Fallot: a novel approach to an older technique

Joan K Lee  1 , Sathish Mallenahalli Chikkabyrappa  2 , Aarti Bhat  2 , Sujatha Buddhe  2
Affiliations

Echocardiographic assessment of right ventricular volume in repaired tetralogy of Fallot: a novel approach to an older technique

Joan K Lee et al. J Echocardiogr. 2022 Jun.

Abstract

Background: In repaired tetralogy of Fallot (rTOF), right ventricular (RV) enlargement leads to poor outcomes. However, evaluating the RV has limitations; cardiac magnetic resonance (CMR) and 3D echocardiography have barriers including cost and accessibility. Traditional echocardiography is limited given the complex geometry and anterior location of the RV. We propose a novel echocardiographic evaluation of RV volume using 2 separate views.

Methods: This is a retrospective study of rTOF patients with echocardiogram, CMR, and exercise tests. By echocardiogram, we collected RV length in parasternal long axis (PLAX), area in 4-chamber (4C) view, and measurements per standard guidelines. RV end-diastolic and end-systolic volume (RVEDV and RVESV) were calculated as 5/9 (4C area * PLAX length).

Results: Forty-five patients with 66 sets of CMR, echocardiogram, and exercise tests were included (mean age 13.3 ± 3.2 years). The echocardiographic RVEDV and RVESV showed strong correlation with CMR parameters (r = 0.81 and 0.72; p≤ 0.0001), and moderate correlation with peak oxygen pulse (0.63 and 0.49; p≤0.0001). Guideline measurements had no significant correlation. Echocardiographic RVEDV and RVESV were higher in those requiring subsequent pulmonary valve replacement. Indexed echocardiographic RVEDV of 93 ml/m2 had 92% sensitivity and 50% specificity (area under curve 0.75 (p = 0.001)) in predicting CMR RV/LV EDV ratio > 2, which is an early indicator for pulmonary valve replacement.

Conclusions: This novel technique correlates strongly with CMR, better than traditional parameters. While echocardiogram will not replace CMR, this method would be useful in predicting the RV volume, progression of dilation, and timing of CMR.

Keywords: Cardiac MRI; Echocardiography; Exercise test; Right ventricular volume; Tetralogy of Fallot.

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References

    1. Hoffman JIE, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002;39:1890–900. - DOI
    1. Wijesekera VA, Raju R, Precious B, et al. Sequential right and left ventricular assessment in posttetralogy of fallot patients with significant pulmonary regurgitation. Congenit Heart Dis. 2016;11(6):606–14. - DOI
    1. Cochran CD, Yu S, Gakenheimer-Smith L, et al. Identifying risk factors for massive right ventricular dilation in patients with repaired tetralogy of Fallot. Am J Cardiol. 2020;125(6):970–6. - DOI
    1. Lu JC, Cotts TB, Agarwal PP, et al. Relation of right ventricular dilation, age of repair, and restrictive right ventricular physiology with patient-reported quality of life in adolescents and adults with repaired tetralogy of Fallot. Am J Cardiol. 2010;106(12):1798–802. - DOI
    1. Gatzoulis MA, Balaji S, Webber SA, et al. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. Lancet. 2000;356(9234):975–81. - DOI

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