Right and left ventricular function assessed by regional wall motion analysis in patients with tetralogy of Fallot

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Abstract

We studied pre- and postoperative regional right and left ventricular wall motion and global ejection fraction in 18 patients with tetralogy of Fallot who had successful repair, and compared these values to those of patients with a history of Kawasaki disease as controls. Right ventricular ejection fraction was significantly lower in the preoperative group (52±4%) than that in the control group (57±4%), and that in the postoperative state (49±4%) was significantly lower than those in the control and preoperative groups. Left ventricular ejection fraction was significantly lower in the preoperative group (56±7%) than that in the control group (61±5%), while that in the postoperative state (64±6%) was significantly higher than those in the control and preoperative groups. Regional ventricular wall motion analysis revealed that shortening fractions in the tricuspid valve region were reduced in the preoperative patients and were persistent even after successful repair; those in the right ventricular outflow tract region were decreased after the correction. Regional left ventricular wall motion showed that shortening fractions in the anterolateral region were improved after the correction. We conclude that right ventricular dysfunction was present in the preoperative patients with tetralogy of Fallot and was persistent even after total correction.

Introduction

Morbidity and mortality after surgical repair for tetralogy of Fallot have progressively declined, and many studies on pre- and postoperative right and left ventricular function have been reported 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13. It is generally accepted that preoperative right 2, 3, 10and left 1, 6, 9, 10, and postoperative right 3, 6, 7, 8, 10ventricular ejection fractions were decreased, whereas conflicting results concerning postoperative left ventricular ejection fractions demonstrated normal 7, 10, 11, 13or reduced values 1, 6, 9. Postoperative abnormalities such as significant residual ventricular septal defect, pulmonary regurgitation, and right ventricular outflow stenosis resulted in a reduction of postoperative right and left ventricular ejection fraction 4, 6, 7, 8, and the right ventricular outflow patch was also considered to depress right ventricular ejection fraction [3]. Additionally, preoperative hypoxemia, a history of hypoxic spells, age at operation, and duration of surgical procedures were possible factors affecting postoperative left ventricular function 5, 9, 12. Since the right ventricular ejection fraction was decreased even in patients without postoperative abnormalities [6], it is important to assess the ventricular function in both pre- and postoperative patients who have undergone successful repair, for an evaluation of surgical effectiveness leading to a preservation of their ventricular function. Although regional ventricular wall motion analysis has been recognized to be useful for assessing ventricular function in pediatric patients 14, 15, 16, 17, 18, little information concerning ventricular wall motion in tetralogy of Fallot is available 19, 20, 21. The purpose of the present study was therefore to analyze regional right and left ventricular wall motion before and after total correction of tetralogy of Fallot, and to clarify the factors which affect ventricular functions.

Section snippets

Patients

Between 1980 and 1991, 41 patients with tetralogy of Fallot underwent corrective surgery in our institution. There were five early deaths (12%). To compare pre- and postoperative ventricular function, 18 patients (15 boys and 3 girls) who underwent successful repair were studied. They had less than 50 mmHg of right ventricular systolic pressure, mild pulmonary regurgitation, and no residual left to right shunt after the correction. Mild pulmonary regurgitation was defined as regurgitant flow

Results

The catheterization data are shown in Table 1. The right ventricular systolic pressure in the postoperative group was significantly decreased, but it was still significantly higher than that in the control group. The right and left ventricular end-diastolic and left ventricular systolic pressures did not show a significant difference among the three groups. Heart rates in the postoperative group were significantly lower than those in the control and preoperative groups.

Ventricular end-diastolic

Discussion

In the present study, patients with a history of Kawasaki disease and who had no coronary arterial lesions at the examinations were chosen as a control group. Kosuda et al. [16]reported that 23% of such patients had hypokinetic segments of left ventricular wall motion even after their coronary lesions had improved to normal. There is no available data on right ventricular wall motion in patients with Kawasaki disease. Thus, the data of our control group should be considered not to be identical

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