Journal of the American Society of Echocardiography
Clinical InvestigationCongenital Heart DiseaseThe Impact of Preexisting Myocardial Remodeling on Ventricular Function Early after Tetralogy of Fallot Repair
Section snippets
Patient Population
We enrolled 23 consecutive patients with tetralogy of Fallot who were electively admitted for corrective surgery at the Heart Institute (InCor), University of São Paulo Medical School, from March 2005 to April 2007. Patient ages ranged from 12 to 186 months (mean = 39.6 months, median = 23 months), and 14 were male (60.9%). Patients with pulmonary atresia or associated atrioventricular septal defect were excluded from the study. Those presenting small atrial septal defects were included.
Before
Clinical and Surgical Features
All corrective surgeries were performed using cardiopulmonary bypass and deep hypothermia. Both the transatrial and transpulmonary approaches were applied in five patients. A transannular patch was used in 10 patients. Six patients had patched widening of the RV outflow tract with no need for a transannular patch. One patient required the insertion of a Dacron conduit between the RV and the pulmonary trunk. The mean bypass time (±SD) was 119.3 ± 37.1 minutes, and the mean aortic crossclamping
Discussion
The postoperative course is usually straightforward in most patients after repair of tetralogy of Fallot. However, it is well known that some patients can experience a prolonged, troublesome postoperative recovery, associated with low cardiac output, increased filling pressures, prolonged ventilation, and inotropic support. Systolic function is usually considered normal in these patients. Abnormalities in RV diastolic function in the immediate postoperative period have been associated with this
Study Limitations
One of the main limitations of our study was that the morphometric data were compared with reference values published previously in the literature, because a control group in this setting would be ethically unacceptable. Another limitation is that all samples were from the subendocardial layer of the myocardium, which could not entirely reflect the remodeling process across the ventricular wall, although it has been demonstrated in necropsy hearts with tetralogy of Fallot that the content of
Conclusions
Myocardial remodeling present preoperatively, as judged by the morphometric histopathologic evaluation of cell hypertrophy and interstitial collagen, has influenced the medium-term postoperative systolic and diastolic RV function, respectively, after tetralogy of Fallot repair. A better understanding of ventricular remodeling and its consequences on ventricular function will provide new insights to deal with an occasionally challenging postoperative course. Further studies are necessary to
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Adverse remodelling in tetralogy of Fallot: From risk factors to imaging analysis and future perspectives
2024, Hellenic Journal of CardiologyRight Ventricular Strain in Patients With Ductal-Dependent Tetralogy of Fallot
2023, Journal of the American Society of EchocardiographyComparison of serum biomarkers of myocardial fibrosis with cardiac magnetic resonance in patients operated for tetralogy of Fallot
2022, International Journal of CardiologyGetting Closer to Predicting SCD in TOF
2022, JACC: Cardiovascular ImagingTwo-dimensional right ventricular strain by speckle tracking for assessment of longitudinal right ventricular function after paediatric congenital heart disease surgery
2017, Archives of Cardiovascular DiseasesCitation Excerpt :We observed a significant decrease in RV function after cardiac surgery, without complete recovery at hospital discharge. This partial recovery of ventricular performance has been noticed in several studies, with several different subgroups of CHD patients, such as great vessels transposition and tetralogy of Fallot surgery [29,30]. Even in long-term follow-up of children with ventricular septal defect, Klitsie et al. found that TAPSE and TA Sa remained impaired for up to 20 months after surgery [31].
Myocardial histopathology in late-repaired and unrepaired adults with tetralogy of Fallot
2016, Cardiovascular PathologyCitation Excerpt :Studies have shown cardiomyocyte hypertrophy and disarray, varying degrees and types of fibrosis, and cardiomyocyte degeneration, thought to be the consequence of high RV pressure and hypoxemia [11–15]. More recent studies have shown hypertrophy and fibrosis of both the RV and LV in unrepaired TOF [16] that increase with age [17] and are associated with cardiac dysfunction and a worse outcome early after repair [18,19]. However, little is known about myocardial histopathology after repair of TOF.
Supported by Fundação de Amparo à Pesquisa do Estado de São Paulo, grant 05/01476-2.