Clinical InvestigationRight Ventricular Performance in Complex Congenital Heart DiseaseQuantification of Right Ventricular Electromechanical Dyssynchrony in Relation to Right Ventricular Function and Clinical Outcomes in Children with Repaired Tetralogy of Fallot
Section snippets
Study Population
We performed a retrospective cross-sectional analysis of echocardiograms between January 2007 and December 2014 at our institution, with approval from the institutional research ethics board. A departmental echocardiography database was used to screen for eligible patients following TOF repair who had sequential echocardiographic and CMR studies. Patients who had a primary diagnosis of an atrioventricular septal defect with TOF or more than minor residual intracardiac shunts were excluded.
Demographics
Of 100 consecutive patients with repaired TOF, 18 were excluded for RVOT gradients > 40 mm Hg, and one was excluded because of poor quality imaging. Consequently, 81 patients with TOF and 50 control subjects were included in the final analysis (Figure 3). The diagnosis was TOF in 71 patients (88%); double-outlet right ventricle, TOF type, in four (5%); pulmonary atresia with TOF in four (5%); and TOF with absent pulmonary valve syndrome in two (2.5%). The median age of complete repair was
Discussion
RV mechanical dyssynchrony is ubiquitous in patients with TOF but has not been systematically quantified, and its association with RV function and clinical parameters as a continuous parameter has not been explored. We sought to describe dyssynchrony severity and its relationship to pathophysiology, RV function, and clinical outcomes in patients with repaired TOF through inefficient stretch and strain, intra-RV mechanical dispersion, and delay, reflecting the underlying pathophysiology. We and
Conclusion
The severity of RV electromechanical dyssynchrony can be quantified by RV basal-lateral prestretch, PSS, RV lateral-septal delays, and mechanical dispersion, which are associated with RV remodeling and dysfunction. In practice, RV basal-lateral prestretch amplitude is simple to measure and correlates with parameters of RV dysfunction, providing a practical approach to assessing RV electromechanical dyssynchrony severity that reflects the underlying pathophysiology. Quantification of RV
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Conflicts of Interest: None.