Key result
Corrected tetralogy of Fallot is linked to ~38% prevalence of LV rigid body rotation.
Why the study?
Data on LV rotational abnormalities and their correlation with aortic elasticity in corrected TOF were conflicting, and the impact of different surgical strategies was unclear.
Do adult patients with corrected tetralogy of Fallot exhibit left ventricular rotational abnormalities and altered correlations with aortic stiffness compared to healthy controls, and do different surgical strategies (early total repair vs. prior palliation with late repair) affect these parameters?
Case-Control (n=63)
Single-blind (experts performing echocardiographic analysis were blinded to clinical data)
No
Do adult patients with corrected tetralogy of Fallot exhibit left ventricular rotational abnormalities and altered correlations with aortic stiffness compared to healthy controls, and do different surgical strategies (early total repair vs. prior palliation with late repair) affect these parameters?
Adults with repaired tetralogy of Fallot have a high prevalence of left ventricular rigid body rotation (38%), more severe impairment of LV apical rotation following delayed repair with prior palliation compared to early total correction, and an absent compensatory LV rotational response to increased aortic stiffness.
Answers are grounded in this paper and cite their sources.
LV rotational abnormalities may prompt enhanced surveillance in adult repaired TOF; leaves open causal links to aortic stiffness and surgical timing.
BACKGROUND: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease (CHD). Abnormal aortic dimensions and elasticity parameters have been long described for corrected TOF (cTOF) together with left ventricular (LV) rotational abnormalities, but results are conflicting. The present study focuses on investigating LV rotational mechanics in cTOF, and possible correlation of these parameters with aortic elasticity. It was also aimed to be examined whether different surgical strategies have any effect on these results. METHODS: The study involved 26 adult cTOF patients, from which 14 had palliative surgery first and a late total correction (pcTOF), while early total correction was the treatment of choice in 12 patients (etrTOF). Their results were compared to those of 37 age- and gender-matched healthy adults. Routine transthoracic two-dimensional Doppler echocardiography extended with assessment of aortic elastic properties and three-dimensional speckle-tracking echocardiography (3DSTE) was performed in all cTOF patients and controls. RESULTS: Sixteen out of 26 cTOF patients showed normally directed LV rotational mechanics, while apical or basal LV rotations were in the same clockwise or counterclockwise directions in 7 and 3 cTOF cases, respectively (LV 'rigid body rotation', RBR). Significantly reduced LV apical rotation and twist could be demonstrated in all cTOF patients with preserved LV basal rotation regardless of previous procedure. pcTOF patients showed significantly reduced LV apical rotation as compared to that of etrTOF cases. Significant correlations could be demonstrated between LV apical rotation and aortic stiffness index (r=-0.55, P=0.03) and aortic distensibility (r=0.52, P=0.04). CONCLUSIONS: Significant LV rotational abnormalities could be demonstrated in cTOF with the high prevalence of LV-RBR. pcTOF patients showed significantly reduced LV apical rotation as compared to that of etrTOF cases. Unexpected abnormal physiologic response of LV rotational mechanics to increased aortic stiffness can be detected in cTOF patients without LV-RBR.
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Nemes et al. (2021) conducted a case-control in Corrected Tetralogy of Fallot (cTOF) (n=63). Corrected tetralogy of Fallot (including early total correction [etrTOF] vs palliative surgery first with late total correction [pcTOF]) vs. 37 age- and gender-matched healthy adult controls (and internal comparison between etrTOF and pcTOF) was evaluated on Normally directed left ventricular rotational mechanics vs. left ventricular rigid body rotation (LV-RBR) and LV apical rotation (degrees) assessed by 3D speckle-tracking echocardiography (p=<0.05). Adult corrected tetralogy of Fallot patients exhibited a 38% prevalence of LV rigid body rotation and reduced LV apical rotation (5.2° vs 10.2°, P<0.05), which correlated with aortic stiffness (r=-0.55).
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