Key result
Tetralogy of Fallot repair with an outflow tract patch was associated with abnormal right ventricular size and pump function, including increased RVEDV (177% of normal) and depressed RVEF (0.45).
Why the study?
How do different surgical approaches (shunt, repair with or without outflow patch) affect right ventricular volume and function in patients with tetralogy of Fallot?
Observational (n=63)
How do different surgical approaches (shunt, repair with or without outflow patch) affect right ventricular volume and function in patients with tetralogy of Fallot?
Right ventricular size and pump function are abnormal in tetralogy of Fallot patients requiring an outflow tract patch, highlighting the hemodynamic consequences of this specific surgical approach.
Answers are grounded in this paper and cite their sources.
Outflow tract patch repair warrants closer RV surveillance in tetralogy of Fallot; leaves open whether alternative techniques better preserve ventricular size and function.
Right heart volume data were obtained in 63 patients with tetralogy of Fallot. The patients were divided into three groups: 1) preoperative tetralogy (N=34); 2) post shunt procedure (N=14); 3A) post repair without outflow patch (N=10); 3B) post repair with an outflow patch (N=8). In Group 1 right ventricular end-diastolic volume (RVEDV), RV ejection fraction (EF), and RV systolic output (SO) were all mildly depressed. In post shunt patients, RVEDV was normal but RVEF remained depressed. RVEDV and RVSO increased following a shunt procedure, and these variables were larger in patients with a large versus a small shunt. In Group 3A RVEDV, RVEF, and RVSO were normal. In contrast in patients in Group 3B, RVEDV was increased averaging 177 +/- 15% of normal RVEF was depressed averaging 0.45 +/- 0.04, and RVSO was normal. RV size and pump function are abnormal in patients whose operation requires an outflow tract patch and the factors which may contribute to these abnormalities include a higher RV peak pressure, pulmonary incompetence, and a larger noncontractile outflow tract. Longitudinal studies relating these variables to clinical performance and exercise testing will be important in assessment of the importance of these abnormalities.
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Graham et al. (1976) conducted an observational in Tetralogy of Fallot (n=63). Surgical repair with an outflow tract patch vs. Preoperative status or repair without patch was evaluated on Right ventricular end-diastolic volume (RVEDV), ejection fraction (RVEF), and systolic output (RVSO). Tetralogy of Fallot repair with an outflow tract patch was associated with abnormal right ventricular size and pump function, including increased RVEDV (177% of normal) and depressed RVEF (0.45).
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