Circulation, Vol 88, 2257-2266, Copyright © 1993 by American Heart Association
SA Rebergen, JG Chin, J Ottenkamp, EE van der Wall and A de Roos
BACKGROUND. Pulmonary regurgitation frequently occurs after surgical
correction of tetralogy of Fallot. To date, reliable quantitation of
pulmonary regurgitation has not been possible, and therefore the clinical
significance of pulmonary regurgitation is controversial. Nuclear magnetic
resonance (NMR) velocity mapping allows accurate measurement of volumetric
flow. The feasibility and accuracy of NMR velocity mapping to quantify
pulmonary regurgitation volumes are studied in patients after Fallot
repair. METHODS AND RESULTS. In 18 patients (mean age, 16.5 +/- 6.5 years),
late (12.6 +/- 5.2 years) after Fallot surgery, forward and regurgitant
volume flow was measured in the main pulmonary artery with NMR velocity
mapping. To validate the measurements of pulmonary forward flow, right
ventricular stroke volume was used as an internal reference standard.
Pulmonary regurgitation volumes were compared with the differences between
the corresponding right and left ventricular stroke volumes. Ventricular
volumes were measured with a multisection gradient echo NMR method. In
addition, the relation between pulmonary regurgitation and right
ventricular volumes was studied. Measurements of pulmonary regurgitation
volume with NMR velocity mapping closely corresponded with the
tomographically determined volumes (r = .93). Forward pulmonary volume flow
was nearly identical to right ventricular stroke volume (r = .98).
Pulmonary regurgitation volume was significantly correlated with
end-diastolic volume (r = .82, P < .0005), end-systolic volume (r = .63,
P < .01), and stroke volume (r = .89, P < .0005) of the right
ventricular but not with right ventricular ejection fraction (r = .41, P =
NS). CONCLUSIONS. NMR velocity mapping is an accurate method for the
noninvasive, volumetric quantification of pulmonary regurgitation after
surgical correction of tetralogy of Fallot.
ARTICLES
Pulmonary regurgitation in the late postoperative follow-up of tetralogy of Fallot. Volumetric quantitation by nuclear magnetic resonance velocity mapping
Interuniversity Cardiology Institute of The Netherlands, Utrecht.
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