Refining the assessment of pulmonary regurgitation in adults after tetralogy of Fallot repair: should we be measuring regurgitant fraction or regurgitant volume?
Eur Heart J
; 30(3): 356-61, 2009 Feb.
Article
in En
| MEDLINE
| ID: mdl-19164336
ABSTRACT
AIMS:
Pulmonary regurgitation (PR) is an important determinant of outcome after tetralogy of Fallot (TOF) repair. The physiologic impact of PR on the right ventricle remains incompletely understood. We hypothesized that a volumetric expression of PR would be a better measure of ventricular preload and a more accurate reflection of degree of insufficiency. METHODS ANDRESULTS:
Patients (n = 64) with magnetic resonance imaging after TOF repair were identified. PR was quantified using (i) phase contrast (PC) analysis of main pulmonary artery flow and (ii) differential right and left ventricular stroke volumes. PR was expressed as a volume (PR(volume)) and percentage of total forward flow (PR(fraction)). The median PC(PR volume) was 19 mL/m(2) (range 0-63 mL/m(2)) and PC(PR fraction) was 29% (range 0-58%). PR(fraction) was found to be highly variable in terms of absolute PR(volume). In those with significant PR, PR(volume) was better than PR(fraction) for the identification of severe RV dilation (receiver-operator curve area 0.83 vs. 0.71, P = 0.003). PR(volume) using PC analysis was better at differentiating moderate from severe RV dilation (P = 0.005) as compared with PR(fraction) (P = 0.064).CONCLUSION:
PR(volume) and PR(fraction) are not interchangeable. PR(volume) may be a more accurate reflection of RV preload and may better represent physiologically significant PR as compared with PR(fraction).
Full text:
1
Database:
MEDLINE
Main subject:
Postoperative Complications
/
Pulmonary Valve Insufficiency
/
Tetralogy of Fallot
Type of study:
Evaluation_studies
/
Observational_studies
/
Prognostic_studies
Limits:
Adult
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Year:
2009
Type:
Article