Timely pulmonary valve replacement may allow preservation of left ventricular circumferential strain in patients with Tetralogy of Fallot

Barbara E.U. Burkhardt; Marí Nieves Velasco Forte; Saravanan Durairaj; Isma Rafiq; Israel Valverde; Animesh Tandon; John Simpson; Tarique Hussain

doi:10.3389/fped.2017.00039

Timely pulmonary valve replacement may allow preservation of left ventricular circumferential strain in patients with Tetralogy of Fallot

Barbara E.U. Burkhardt^*, Marí Nieves Velasco Forte, Saravanan Durairaj, Isma Rafiq, Israel Valverde, Animesh Tandon, John Simpson, Tarique Hussain

^*Corresponding author for this work

Kinderspital Zurich, Fak Med

Research output: Contribution to journal › Article › peer-review

8 Citations (Scopus)

Abstract

Introduction: Patients with Tetralogy of Fallot (TOF) and pulmonary insufficiency and a dilated right ventricle (RV) may suffer from a reduction in left ventricular (LV) performance. It is not clear whether timely pulmonary valve replacement (PVR) preserves LV mechanics. Methods: Ten TOF patients who underwent PVR were identified from hospital records, and pre- and postoperative cardiac magnetic resonance images were post-processed with a semi-automatic tissue tracking software. LV circumferential strain, time to peak strain, and torsion were compared before and after PVR. A control group of 10 age-matched normal volunteers was assessed as a comparison. Results: LV circumferential strain did not change before vs. after PVR (basal -18.3 ± 3.7 vs. -20.5 ± 3%, p = 0.082; mid-ventricular -18.4 ± 3.6 vs. -19.1 ± 2%, p = 0.571; apical -22.7 ± 5.2 vs. -22.1 ± 4%; p = 0.703). There was also no difference seen between the baseline strain and normal controls (control basal -18.2 ± 3.3%, p = 0.937; mid -18 ± 3.2%, p = 0.798; apex -24.1 ± 5%, p = 0.552). LV torsion remained unchanged from baseline to post PVR [systolic 2.75 (1.23-9.51) °/cm vs. 2.3 ± 1.2°/cm, p = 0.285; maximum 5.5 ± 3.5°/cm vs. 2.34 (1.37-8.07) °/cm, p = 0.083]. There was no difference in time to measured peak LV circumferential strain before vs. after PVR (basal 0.44 ± 0.1 vs. 0.43 ± 0.05, p = 0.912; mid-ventricular 0.42 ± 0.08 vs. 0.38 ± 0.06, p = 0.186; apical 0.40 ± 0.08 vs. 0.40 ± 0.06, p = 0.995). At the same time, pulmonary regurgitation and RV end-diastolic and end-systolic volume indices decreased and LV end-diastolic volume increased after PVR. RV and LV ejection fractions remained constant. Conclusion: PVR allows for favorable remodeling of both ventricular volumes for TOF patients with significant pulmonary regurgitation. In this cohort, LV myocardial functional parameters such as circumferential strain, time to peak strain, and LV torsion were normal at baseline and remain unchanged after PVR.

Original language	English
Article number	39
Journal	Frontiers in Pediatrics
Volume	5
DOIs	https://doi.org/10.3389/fped.2017.00039
Publication status	Published - 28 Feb 2017

Keywords

Congenital heart defects
Left ventricle
Magnetic resonance
Myocardial function
Pulmonary valve replacement
Strain
Tetralogy of Fallot
Tissue tracking

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10.3389/fped.2017.00039Licence: CC BY

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@article{1a534571aaa945939fac6df4623031a7,

title = "Timely pulmonary valve replacement may allow preservation of left ventricular circumferential strain in patients with Tetralogy of Fallot",

abstract = "Introduction: Patients with Tetralogy of Fallot (TOF) and pulmonary insufficiency and a dilated right ventricle (RV) may suffer from a reduction in left ventricular (LV) performance. It is not clear whether timely pulmonary valve replacement (PVR) preserves LV mechanics. Methods: Ten TOF patients who underwent PVR were identified from hospital records, and pre- and postoperative cardiac magnetic resonance images were post-processed with a semi-automatic tissue tracking software. LV circumferential strain, time to peak strain, and torsion were compared before and after PVR. A control group of 10 age-matched normal volunteers was assessed as a comparison. Results: LV circumferential strain did not change before vs. after PVR (basal -18.3 ± 3.7 vs. -20.5 ± 3%, p = 0.082; mid-ventricular -18.4 ± 3.6 vs. -19.1 ± 2%, p = 0.571; apical -22.7 ± 5.2 vs. -22.1 ± 4%; p = 0.703). There was also no difference seen between the baseline strain and normal controls (control basal -18.2 ± 3.3%, p = 0.937; mid -18 ± 3.2%, p = 0.798; apex -24.1 ± 5%, p = 0.552). LV torsion remained unchanged from baseline to post PVR [systolic 2.75 (1.23-9.51) °/cm vs. 2.3 ± 1.2°/cm, p = 0.285; maximum 5.5 ± 3.5°/cm vs. 2.34 (1.37-8.07) °/cm, p = 0.083]. There was no difference in time to measured peak LV circumferential strain before vs. after PVR (basal 0.44 ± 0.1 vs. 0.43 ± 0.05, p = 0.912; mid-ventricular 0.42 ± 0.08 vs. 0.38 ± 0.06, p = 0.186; apical 0.40 ± 0.08 vs. 0.40 ± 0.06, p = 0.995). At the same time, pulmonary regurgitation and RV end-diastolic and end-systolic volume indices decreased and LV end-diastolic volume increased after PVR. RV and LV ejection fractions remained constant. Conclusion: PVR allows for favorable remodeling of both ventricular volumes for TOF patients with significant pulmonary regurgitation. In this cohort, LV myocardial functional parameters such as circumferential strain, time to peak strain, and LV torsion were normal at baseline and remain unchanged after PVR.",

keywords = "Congenital heart defects, Left ventricle, Magnetic resonance, Myocardial function, Pulmonary valve replacement, Strain, Tetralogy of Fallot, Tissue tracking",

author = "Burkhardt, {Barbara E.U.} and Forte, {Mar{\'i} Nieves Velasco} and Saravanan Durairaj and Isma Rafiq and Israel Valverde and Animesh Tandon and John Simpson and Tarique Hussain",

year = "2017",

month = feb,

day = "28",

doi = "10.3389/fped.2017.00039",

language = "English",

volume = "5",

journal = "Front Pediatr",

issn = "2296-2360",

publisher = "Frontiers Media S.A.",

}

TY - JOUR

T1 - Timely pulmonary valve replacement may allow preservation of left ventricular circumferential strain in patients with Tetralogy of Fallot

AU - Burkhardt, Barbara E.U.

AU - Forte, Marí Nieves Velasco

AU - Durairaj, Saravanan

AU - Rafiq, Isma

AU - Valverde, Israel

AU - Tandon, Animesh

AU - Simpson, John

AU - Hussain, Tarique

PY - 2017/2/28

Y1 - 2017/2/28

N2 - Introduction: Patients with Tetralogy of Fallot (TOF) and pulmonary insufficiency and a dilated right ventricle (RV) may suffer from a reduction in left ventricular (LV) performance. It is not clear whether timely pulmonary valve replacement (PVR) preserves LV mechanics. Methods: Ten TOF patients who underwent PVR were identified from hospital records, and pre- and postoperative cardiac magnetic resonance images were post-processed with a semi-automatic tissue tracking software. LV circumferential strain, time to peak strain, and torsion were compared before and after PVR. A control group of 10 age-matched normal volunteers was assessed as a comparison. Results: LV circumferential strain did not change before vs. after PVR (basal -18.3 ± 3.7 vs. -20.5 ± 3%, p = 0.082; mid-ventricular -18.4 ± 3.6 vs. -19.1 ± 2%, p = 0.571; apical -22.7 ± 5.2 vs. -22.1 ± 4%; p = 0.703). There was also no difference seen between the baseline strain and normal controls (control basal -18.2 ± 3.3%, p = 0.937; mid -18 ± 3.2%, p = 0.798; apex -24.1 ± 5%, p = 0.552). LV torsion remained unchanged from baseline to post PVR [systolic 2.75 (1.23-9.51) °/cm vs. 2.3 ± 1.2°/cm, p = 0.285; maximum 5.5 ± 3.5°/cm vs. 2.34 (1.37-8.07) °/cm, p = 0.083]. There was no difference in time to measured peak LV circumferential strain before vs. after PVR (basal 0.44 ± 0.1 vs. 0.43 ± 0.05, p = 0.912; mid-ventricular 0.42 ± 0.08 vs. 0.38 ± 0.06, p = 0.186; apical 0.40 ± 0.08 vs. 0.40 ± 0.06, p = 0.995). At the same time, pulmonary regurgitation and RV end-diastolic and end-systolic volume indices decreased and LV end-diastolic volume increased after PVR. RV and LV ejection fractions remained constant. Conclusion: PVR allows for favorable remodeling of both ventricular volumes for TOF patients with significant pulmonary regurgitation. In this cohort, LV myocardial functional parameters such as circumferential strain, time to peak strain, and LV torsion were normal at baseline and remain unchanged after PVR.

AB - Introduction: Patients with Tetralogy of Fallot (TOF) and pulmonary insufficiency and a dilated right ventricle (RV) may suffer from a reduction in left ventricular (LV) performance. It is not clear whether timely pulmonary valve replacement (PVR) preserves LV mechanics. Methods: Ten TOF patients who underwent PVR were identified from hospital records, and pre- and postoperative cardiac magnetic resonance images were post-processed with a semi-automatic tissue tracking software. LV circumferential strain, time to peak strain, and torsion were compared before and after PVR. A control group of 10 age-matched normal volunteers was assessed as a comparison. Results: LV circumferential strain did not change before vs. after PVR (basal -18.3 ± 3.7 vs. -20.5 ± 3%, p = 0.082; mid-ventricular -18.4 ± 3.6 vs. -19.1 ± 2%, p = 0.571; apical -22.7 ± 5.2 vs. -22.1 ± 4%; p = 0.703). There was also no difference seen between the baseline strain and normal controls (control basal -18.2 ± 3.3%, p = 0.937; mid -18 ± 3.2%, p = 0.798; apex -24.1 ± 5%, p = 0.552). LV torsion remained unchanged from baseline to post PVR [systolic 2.75 (1.23-9.51) °/cm vs. 2.3 ± 1.2°/cm, p = 0.285; maximum 5.5 ± 3.5°/cm vs. 2.34 (1.37-8.07) °/cm, p = 0.083]. There was no difference in time to measured peak LV circumferential strain before vs. after PVR (basal 0.44 ± 0.1 vs. 0.43 ± 0.05, p = 0.912; mid-ventricular 0.42 ± 0.08 vs. 0.38 ± 0.06, p = 0.186; apical 0.40 ± 0.08 vs. 0.40 ± 0.06, p = 0.995). At the same time, pulmonary regurgitation and RV end-diastolic and end-systolic volume indices decreased and LV end-diastolic volume increased after PVR. RV and LV ejection fractions remained constant. Conclusion: PVR allows for favorable remodeling of both ventricular volumes for TOF patients with significant pulmonary regurgitation. In this cohort, LV myocardial functional parameters such as circumferential strain, time to peak strain, and LV torsion were normal at baseline and remain unchanged after PVR.

KW - Congenital heart defects

KW - Left ventricle

KW - Magnetic resonance

KW - Myocardial function

KW - Pulmonary valve replacement

KW - Strain

KW - Tetralogy of Fallot

KW - Tissue tracking

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U2 - 10.3389/fped.2017.00039

DO - 10.3389/fped.2017.00039

M3 - Article

AN - SCOPUS:85042004079

SN - 2296-2360

VL - 5

JO - Front Pediatr

JF - Front Pediatr

M1 - 39

ER -

Timely pulmonary valve replacement may allow preservation of left ventricular circumferential strain in patients with Tetralogy of Fallot

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