Background: We explored the accuracy of transesophageal strain Doppler echocardiography in detecting RV dysfunction in patients (pts) with postoperative tetralogy of Fallot (T/F) and hemodinamically significant pulmonary regurgitation (PR). Methods: Transesophageal echocardiography with TDI and strain capabilities was performed in 14 pts aged 13-45 years who had repair of T/F. 12 age- and sex-matched subjects with no signs of heart disease were selected as normal controls (CTR). A thorough esophageal, low esophageal and transgastric scanning was performed. The ratio of PR jet width measured by color Doppler to the infundibulum diameter was used to quantify the severity of PR (ratio >50% = moderate to severe PR). Right ventricular ejection fraction (EF), fractional shortening (FS), and tricuspid flow filling parameters (E/A ratio, DT) were determined. Offline analysis of the myocardial velocity data sets was performed using dedicated software. Velocity and strain traces from right ventricular free wall at 3 levels (basal, mid cavity, and apical) were processed in the esophageal 4-chamber view. Systolic and diastolic TDI values (Sw, Ew, Aw), peak systolic strain and systolic and diastolic strain rate values were determined. Results: Three pts presented with severely dilated RV and decreased fractional area change for progressive pulmonary insufficiency due to an outflow patch and were excluded from analysis. 11 pts with dilated RV and normal fractional area change were analysed. Ew/Aw ratio was lower in pts than in CTR (p<0.005). Peak systolic strain and systolic and diastolic strain rate were also reduced in pts compared to CTR (p<0.001). E/A ratio and DT were not different among the two groups. No correlation was found between E/A ratio, DT, and severity of PR. A highly significant relationship was shown between early diastolic SR and degree of PR (r=-0.79, p<0.001). Conclusion: In adolescent and adult pts after repair of T/F, TEE is recommended to assess morphofunctional details especially when transthoracic images are limited by paucity of acoustic windows. In the presence of hemodinamically significant pulmonary regurgitation, strain Doppler echocardiography can detect RV systo-diastolic impairment not shown by conventional echo-Doppler echocardiography.
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|Titolo:||Evaluation of right ventricular function in patients with post-operative pulmonary regurgitation by transesophageal echocardiography|
|Data di pubblicazione:||2005|
|Appartiene alla tipologia:||04c Atto di convegno in rivista|