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Assessment of Right Ventricular Function in Significant Pulmonary Regurgitation after Surgical Correction of Tetralogy of Fallot and Pulmonary Stenosis

Efr?n Mart?nez-Quintana, Fayna Rodr?guez-Gonz?lez, Jos? Mar?n and Vicente Nieto-Lago

Introduction: Pulmonary Regurgitation (PR) is common after surgical repair of Tetralogy of Fallot and pulmonary stenosis leading to progressive right ventricular dysfunction. Therefore, right ventricular function assessment is crucial to indicate valve replacement.
Methods: 17 patients with moderate or more than moderate pulmonary regurgitation operated in the infancy of Tetralogy of Fallot or pulmonary stenosis were studied. Patients’ demographics, surgery, postoperative functional status, electrocardiogram, stress testing, and NT pro-BNP levels were determined. Also transthoracic echocardiogram and Cardiac Magnetic Resonance (CMR) imaging to assess right ventricular ejection fraction were obtained.
Results: 12 (70.6%) patients were male and the mean age was 30.8 ± 11.9 years old. Time from the surgery to the study was 22.7 ± 9.8 years. Right ventricle ejection fraction was calculated by Simpson (51.0 ± 11.9%), tricuspid annular plane systolic excursion (TAPSE) (18.7 ± 3.7 mm ~ 47.4 ± 7.3%), and CMR imaging (40.7 ± 8.8%). The Pearson’s correlation was r=0.116 for global Simpson vs. CMR, r=0.462 for TAPSE vs. CMR and r=0.453 for TDI vs. CMR. TDI systolic annular velocity (Sa) was 11.0 ± 2.6 cm/s, predicting a Sa value≤11.5 cm/s right ventricular dysfunction (RVEF<45%) calculated by CMR with a sensitivity of 90% and a specificity of 50 %. All patients had good exercise test capacity, no arrhythmias in 24 hour ambulatory electrocardiogram and normal brain natriuretic peptides levels.
Conclusions: TDI systolic motion velocity at the tricuspid annulus allows a high sensitivity to detect patients with right ventricular dysfunction. Normal stress testing capacity, no arrhythmias in 24 hour holter monitoring and normal NT pro-BNP levels were seen despite right ventricular dysfunction.