Abstract 13159: Effect of Pulmonary Valve Replacement on Function and Right Ventricular Volume by Cardiac Magnetic Resonance Imaging in Patients With Repaired Tetralogy of Fallot

• Published in: Circulation (New York, N.Y.) Vol. 140; no. Suppl_1 Suppl 1; p. A13159
• Main Authors: Kollar, Sarah E, Klas, Berthold, Mosha, Maua H, Channing, Alexandra T, Walling, Steven, Toro-Salazar, Olga H
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 19.11.2019
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.140.suppl_1.13159

BackgroundPatients status post tetralogy of Fallot (TOF) repair experience RV volume load due to pulmonary insufficiency. We previously demonstrated RV end diastolic volume index (EDVi) inversely correlates with LV septal segmental displacement, Figure 1. We sought to evaluate recovery of segmental displacement and decrease in RVEDVi following pulmonary valve replacement (PVR) and its effect on RV/LV global and regional function.MethodsFrom 2011 to 2016, pre and post cardiac MR (CMR) studies were obtained in 16 TOF patients on average 5.5 years following PVR. RV/LV myocardial deformation and segmental displacement were quantified using CMR Tissue Tracking software (2D CPA MR, TomTec). Correlations of segmental displacement were performed with RV EF, LV EF, RVEDVi, pulmonary regurgitant fraction (RF), and strain.ResultsPulmonary RF and RVEDVi decreased post PVR in 91.7% and 93.3% of patients. On average, RVEDVi decreased from 154.4 ml/m to 111.2 ml/m post-op, Figure 2. Overall, LV EF and RV EF declined in 81.3% and 75% of patients. Patients with lower RVEDVi showed improved RV septal wall strain magnitude (r = 0.618, P = 0.01) and improved RV EF (r = -0.609, P = 0.01). Patients with recovered LV septal segmental displacement had an increase in LV septal wall strain magnitude (r= 0.617, P = 0.01).ConclusionsOverall,RVEDVi and pulmonary RF improved after PVR, however, LV EF and RV EF continued to decline. RV remodeling with recovery of septal displacement and smaller RVEDVi correlated with improved RV/LV global and regional functional parameters. Future longitudinal studies may help elucidate the use of septal segmental displacement in determining optimal timing for PVR.