(Circulation. 1995;91:1775-1781.)
© 1995 American Heart Association, Inc.
Articles |
Right Ventricular Diastolic Function 15 to 35 Years After Repair of Tetralogy of Fallot
Restrictive Physiology Predicts Superior Exercise Performance
From the Royal Brompton Hospital and the National Heart and Lung Institute (M.A.G., A.L.C., S.C., A.N.R.), London, and Chelsea and Westminster Hospital (C.G.H.N.), London.
Correspondence to Dr Andrew N. Redington, Department of Paediatric Cardiology, Royal Brompton Hospital and the National Heart and Lung Institute, Sydney St, London SW3 6NP, England.
Background We have shown previously that transient right ventricular restriction after tetralogy of Fallot repair prolongs postoperative course. This is a prospective study of right ventricular diastolic performance in late follow-up patients.
Methods and Results We studied biventricular function, using
Doppler echocardiographic examination. Pulmonary arterial, tricuspid,
and mitral valves and superior vena cava Doppler spectrals were
obtained in 41 patients (mean age, 28.8 years), 15 to 35 years (mean,
23.6) after complete repair of tetralogy of Fallot. Patients were
considered to have evidence of right ventricular restriction if
antegrade diastolic flow was detected in the main pulmonary artery,
coinciding with atrial systole (A wave), throughout the respiratory
cycle. Exercise function was measured by graded treadmill testing with
respiratory mass spectrometry. Three patients were excluded because of
pulmonary outflow obstruction (Doppler gradient >40 mm Hg) or
residual intracardiac shunts. Of the 38 patients, 37 were in sinus
rhythm. Twenty (52.6%) had definite evidence of restriction with an A
wave in the pulmonary artery, augmented during inspiration. In all 20
cases, there was superior vena caval flow reversal with atrial systole.
Both inspiratory and expiratory transtricuspid E-wave deceleration time
was significantly shorter in the restrictive group (P<.003
and P<.03, respectively). All patients had Doppler evidence
of pulmonary regurgitation, but its duration was shorter in the
restrictive group (P<.01) during inspiration.
Cardiothoracic ratio was significantly lower in the restrictive group
(P<.01), suggesting less severe pulmonary regurgitation.
Both restrictive and nonrestrictive groups had reduced exercise
M
O2 compared with healthy age- and
sex-matched control subjects, but those with restrictive physiology had
significantly better maximum oxygen uptake than the nonrestrictive
group (P<.001).
Conclusions Isolated right ventricular restriction late after tetralogy of Fallot repair is common. Although it reflects abnormal hemodynamics, the A wave contributes to forward pulmonary arterial flow and shortens the duration of pulmonary regurgitation. Consequently, there is less cardiomegaly and improved exercise performance in those patients.
Key Words: tetralogy of Fallot • echocardiography • exercise • ventricles
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