Key result
Repaired tetralogy of Fallot shows delayed tricuspid flow in ~52% of patients, linked to reduced RVEF.
Why the study?
Diastolic dysfunction of the right ventricle after tetralogy of Fallot repair is common, but early diastolic dysfunction has not been described.
Is delayed onset of tricuspid valve flow common after tetralogy of Fallot repair and associated with right ventricular dysfunction?
Cross-Sectional (n=45)
No
Is delayed onset of tricuspid valve flow common after tetralogy of Fallot repair and associated with right ventricular dysfunction?
Early diastolic dysfunction characterized by delayed onset of tricuspid valve flow is common after tetralogy of Fallot repair and is associated with reduced right ventricular ejection fraction.
Answers are grounded in this paper and cite their sources.
Common post-TOF repair early RV diastolic dysfunction via delayed TV flow associates with reduced RVEF; leaves open its value for risk stratification.
BACKGROUND: Diastolic dysfunction of the right ventricle (RV) is common after repair of tetralogy of Fallot. While restrictive physiology in late diastole has been well known, dysfunction in early diastole has not been described. The present study sought to assess the prevalence and mechanism of early diastolic dysfunction of the RV defined as delayed onset of the tricuspid valve (TV) flow after TOF repair. METHODS: The study population consisted of 31 children with repaired TOF (mean age ± SD, 12.3 ± 4.1 years) who underwent postoperative cardiovascular magnetic resonance (CMR). The CMR protocol included simultaneous phase-contrast velocity mapping of the atrioventricular valves, which enabled direct comparison of the timing and patterns of tricuspid (TV) and mitral (MV) valve flow. The TV flow was defined to have delayed onset when its onset was > 20 ms later than the onset of the MV flow. The TV and MV flow from 14 normal children was used for comparison. The CMR results were correlated with the findings on echocardiography and electrocardiography. RESULT: Delayed onset of the TV flow was observed in 16/31 patients and in none of the controls. The mean delay time was 64.81 ± 27.07 ms (8.7 ± 3.2% of R-R interval). The delay time correlated with the differences in duration of the TV and MV flow (55.94 ± 32.88 ms) (r = 0.90, p < 0.001). Delayed onset was associated with prolongation of the RV ejection time in 9 and delayed onset and cessation of the pulmonary arterial flow in 4. Delayed onset was not associated with timing changes in the pulmonary artery in 3. The patients with delayed onset showed reduced RV ejection fraction (p = 0.01). However, the two groups did not show significant differences in TV E/A ratio, ventricular end-diastolic volumes, left ventricular ejection fraction, pulmonary regurgitant fraction, heart rate, PR interval and QRS duration. CONCLUSIONS: Early diastolic dysfunction with delayed onset of TV flow is common after TOF repair, and is associated with reduced RV ejection fraction. It is a further manifestation of interventricular dyssynchrony and represent an additional mechanism of ventricular diastolic dysfunction.
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Sun et al. (2011) conducted a cross-sectional in Repaired tetralogy of Fallot (n=45). Repaired tetralogy of Fallot vs. Normal controls was evaluated on Prevalence of delayed onset of the tricuspid valve flow (>20 ms later than mitral valve flow) (p=<0.001). Delayed onset of tricuspid valve flow was observed in 52% of patients with repaired tetralogy of Fallot compared to 0% of controls (p < 0.001), and was associated with reduced right ventricular ejection fraction.
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