Transesophageal echocardiographic evaluation of right ventricular function post repair of tetralogy of Fallot

Objectives: The aim was to provide an approach for quantitative evaluation of right ventricular outflow tract (RVOT) and right ventricular (RV) size and function in patients (pts) with postoperative tetralogy of Fallot (T/F). Methods: 17 pts aged 13-52 years were studied with transesophageal echocardiography (TEE). 14 pts were in sinus rhythm and 7 were in atrial fibrillation. RV body was demonstrated and fractional area change (FAC) calculated. Tissue Doppler imaging (TDI) of the tricuspid annulus was used to acquire its diastolic velocities Ea and Aa. The ratio of pulmonary insufficiency (PI) jet width measured by color Doppler to the infundibulum diameter was used to quantify the severity of PI (ratio >50% = moderate to severe PI). Expanded transgastric imaging allowed for a good alignment to flow within the RVOT, thus enabling the accurate calculation of pressure gradients. Results: Ten pts had normal or nearly normal RV size. 4 pts presented with severely dilated RV and decreased RV function parameters (FAC, Ea/Aa) for progressive pulmonary insufficiency due to an outflow patch. 1 pt presented with RV dilation plus moderate to severe tricuspid insufficiency, and 2 pts demonstrated stenosis and insufficiency of previously placed conduit valves. These study findings indicate the utility of a complete multiplane transesophageal echocardiographic assessment in adolescent and adult pts after repair of T/F. Conclusions: Since pulmonary valve replacement is frequently considered for pts with progressive PI and severe RV dilation or a second valve replacement for dysfunctioning conduits, multiplane TEE is recommended to assess morphofunctional details especially when transthoracic images are limited by paucity of acoustic windows.