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European Journal of Echocardiography Advance Access originally published online on March 31, 2009
European Journal of Echocardiography 2009 10(5):641-646; doi:10.1093/ejechocard/jep025
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Ventricular interaction in children after repair of tetralogy of Fallot: a longitudinal echocardiographic study

Katarina Zervan1, Christoph Male1, Thomas Benesch2 and Ulrike Salzer-Muhar1,*

1 Division of Paediatric Cardiology, Department of Paediatric and Adolescent Medicine, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
2 Department of Medical Statistics, Medical University of Vienna, Vienna, Austria

Received 26 October 2008; accepted after revision 7 March 2009; online publish-ahead-of-print 31 March 2009.

* Corresponding author. Tel: +43 1 40400 3292; fax: +43 1 40400 3417. E-mail address: ulrike.salzer{at}meduniwien.ac.at


  Abstract

Aims: Progressive right ventricular (RV) dilation due to pulmonary regurgitation (PR) after repair of tetralogy of Fallot (TOF) may impair left ventricular (LV) filling. Our aim was to analyse long-term time courses of M-mode LV and RV measurements and to relate these to the degree of PR.

Methods and results: Retrospective longitudinal cohort of children (n = 88) after repair of TOF followed by serial echocardiography over 9 years. LV and RV diameters were expressed by z-scores based on normal paediatric reference values. Time courses of LV and RV diameter z-scores, degree of PR, and influence of co-variables were analysed using mixed regression models. LV diameter z-scores were significantly lowered before repair, increased after surgery, but fell again over time; thus, mean LV diameters were significantly lower than normal population means at all times. LV diameter z-scores correlated negatively with RV dilation and degree of PR. Notably, they were significantly higher in patients with previous shunts. After pulmonary valve replacement, LV diameter z-scores recovered to normal, whereas RV diameter z-scores remained abnormal.

Conclusion: Our results confirm progressive adverse RV–LV interaction in the long-term post-operative follow-up of TOF. The use of z-scores facilitated the analysis of time courses of LV and RV diameters.

Keywords: Tetralogy of Fallot; Pulmonary regurgitation; Longitudinal course; Ventricular interaction; Echocardiography


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