Document Detail


Refining the assessment of pulmonary regurgitation in adults after tetralogy of Fallot repair: should we be measuring regurgitant fraction or regurgitant volume?
MedLine Citation:
PMID:  19164336     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: Pulmonary regurgitation (PR) is an important determinant of outcome after tetralogy of Fallot (TOF) repair. The physiologic impact of PR on the right ventricle remains incompletely understood. We hypothesized that a volumetric expression of PR would be a better measure of ventricular preload and a more accurate reflection of degree of insufficiency. METHODS AND RESULTS: Patients (n = 64) with magnetic resonance imaging after TOF repair were identified. PR was quantified using: (i) phase contrast (PC) analysis of main pulmonary artery flow and (ii) differential right and left ventricular stroke volumes. PR was expressed as a volume (PR(volume)) and percentage of total forward flow (PR(fraction)). The median PC(PR volume) was 19 mL/m(2) (range 0-63 mL/m(2)) and PC(PR fraction) was 29% (range 0-58%). PR(fraction) was found to be highly variable in terms of absolute PR(volume). In those with significant PR, PR(volume) was better than PR(fraction) for the identification of severe RV dilation (receiver-operator curve area: 0.83 vs. 0.71, P = 0.003). PR(volume) using PC analysis was better at differentiating moderate from severe RV dilation (P = 0.005) as compared with PR(fraction) (P = 0.064). CONCLUSION: PR(volume) and PR(fraction) are not interchangeable. PR(volume) may be a more accurate reflection of RV preload and may better represent physiologically significant PR as compared with PR(fraction).
Authors:
Rachel M Wald; Andrew N Redington; Andre Pereira; Yves L Provost; Narinder S Paul; Erwin N Oechslin; Candice K Silversides
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-01-22
Journal Detail:
Title:  European heart journal     Volume:  30     ISSN:  1522-9645     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-02-02     Completed Date:  2009-03-24     Revised Date:  2009-07-15    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  356-61     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, North Wing, 5N-517, 585 University Avenue, Toronto, Ontario, Canada M5G 2C4. rachel.wald@uhn.on.ca
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MeSH Terms
Descriptor/Qualifier:
Adult
Female
Humans
Magnetic Resonance Imaging / methods
Male
Middle Aged
Observer Variation
Postoperative Complications / diagnosis*
Pulmonary Artery / physiopathology
Pulmonary Valve Insufficiency / diagnosis*,  etiology*
Retrospective Studies
Stroke Volume
Tetralogy of Fallot / surgery*
Ventricular Function, Left
Ventricular Function, Right
Young Adult
Comments/Corrections
Comment In:
Eur Heart J. 2009 Jul;30(14):1807; author reply 1087-8   [PMID:  19502229 ]

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