Key result
Pulmonary valve replacement significantly improved right ventricular global longitudinal strain from -13.10% to -15.31% and left ventricular global longitudinal strain from -15.24% to -16.79% at 7.4 months post-operation.
Why the study?
In repaired Tetralogy of Fallot, pulmonary regurgitation and RV and LV dysfunction are linked to adverse outcomes, prompting echocardiographic assessment before and after pulmonary valve replacement to inform timing of operation.
Does Pulmonary Valvular Replacement improve left and right ventricular function assessed by strain analysis in children with repaired Tetralogy of Fallot?
Cross-Sectional (n=30)
No
Does Pulmonary Valvular Replacement improve left and right ventricular function assessed by strain analysis in children with repaired Tetralogy of Fallot?
Absolute Event Rate: -15.31% vs -13.1%
p-value: p=<0.001
Pulmonary valve replacement in children with repaired Tetralogy of Fallot significantly improves both left and right ventricular global longitudinal strain at approximately 7 months post-operation.
Supports late strain recovery assessment after PVR in repaired TOF; hypothesis-generating for timing trials.
BACKGROUND: In repaired Tetralogy of Fallot (rTOF), pulmonary regurgitation and resulting right ventricular (RV) and left ventricular (LV) dysfunction are associated with adverse clinical outcomes. We performed an echocardiographic assessment of LV and RV function using Global Longitudinal Strain (GLS) and conventional echo method prior to and following Pulmonary Valvular Replacement (PVR) to help inform proper timing of operation. RESULTS: A total of 30 rTOF patients (12.17 ± 2.5 years, 70% male) were included. Regarding to LV function, the study revealed a significant reverse correlation between LV GLS (absolute value) and early (mean = 10.4 days) and late (mean = 7.4 months) postop LVEF. Paired T-Test showed significant difference between GLS of LV and RV before and late after operation (op), however, without significant changes early postop. Late postop significant improvements occurred in other conventional echo indices of LV and RV function as well. There was also a significant correlation between echo-measured LVEF & Fraction Area Change (RV FAC) and MRI-derived LVEF & RVEF, respectively. CONCLUSION: In this cross-sectional study in rTOF patients, RV and LV GLS as well as conventional echocardiographic indices regarding LV and RV function improved significantly after 6 months (mean = 7.4mo) following PVR.
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Moradian et al. (2023) conducted a cross-sectional in Repaired Tetralogy of Fallot with severe pulmonary regurgitation (n=30). Pulmonary Valvular Replacement (PVR) vs. Pre-operative baseline was evaluated on Right ventricular global longitudinal strain (RV GLS) at late post-operation (p=<0.001). Pulmonary valve replacement significantly improved right ventricular global longitudinal strain from -13.10% to -15.31% and left ventricular global longitudinal strain from -15.24% to -16.79% at 7.4 months post-operation.
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