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Assessment of inter-atrial, inter-ventricular, and atrio-ventricular interactions in tetralogy of Fallot patients after surgical correction. Insights from two-dimensional speckle tracking and three-dimensional echocardiography

  • Mohamed Abd El Rahman (a1) (a2), Tanja Raedle-Hurst (a1), Axel Rentzsch (a1), Hans-Joachim Schäfers (a3) and Hashim Abdul-Khaliq (a1)...
Abstract
Abstract

Background: We aimed to assess biatrial size and function, interactions on atrial and ventricular levels, and atrio-ventricular coupling in patients after tetralogy of Fallot repair. Methods: A total of 34 patients with a mean age of 20.9±9 years, and 35 healthy controls, underwent two-dimensional speckle tracking echocardiography for ventricular and atrial strain measurements and real-time three-dimensional echocardiography to assess ventricular and atrial volumes. Results: When compared with controls, tetralogy of Fallot patients had significantly reduced right atrial peak atrial longitudinal strain (p<0.01), right atrial peak atrial contraction strain (p<0.01), right atrial ejection fraction (p<0.01), left atrial peak atrial longitudinal strain (p<0.01), left atrial peak atrial contraction strain (p<0.05), and left atrial ejection fraction (p<0.01). In the tetralogy of Fallot group, left ventricular ejection fraction was negatively related to the right ventricular end-systolic volume normalised to body surface area (r=−0.62, p<0.01). An association was found in patients between the right atrial peak longitudinal strain and mean right ventricular strain (r=0.64, p<0.01). In patients, the left atrial peak longitudinal strain correlated negatively with right atrial end-diastolic volume normalised to body surface area (r=−0.67, p<0.01), whereas the left atrial ejection fraction correlated weakly with left ventricular ejection fraction (r=0.41, p<0.05). Conclusions: In asymptomatic tetralogy of Fallot patients, biatrial dysfunction exists and can be quantified via two-dimensional speckle tracking echocardiography as well as real-time three-dimensional echocardiography. Different forms of interactions on atrial and ventricular levels are evident among such cohorts.

Copyright
Corresponding author
Correspondence to: Prof. Dr H. Abdul-Khaliq, MD, PhD, Department of Paediatric Cardiology, Saarland University Hospital, Kirrberger Straße, 66421 Homburg/Saar, Germany. Tel: +496 841 162 8306; Fax: +496 841 162 8330; E-mail: Hashim.Abdul-Khaliq@uniklinikum-saarland.de
References
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1. Bashore TM. Adult congenital heart disease: right ventricular outflow tract lesions. Circulation 2007; 115: 19331947.
2. Murphy JG, Gersh BJ, Mair DD, et al. Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot. N Engl J Med 1993; 329: 593599.
3. Abd El Rahman MY, Abdul-Khaliq H, Vogel M, et al. Value of the new Doppler-derived myocardial performance index for the evaluation of right and left ventricular function following repair of tetralogy of fallot. Pediatr Cardiol 2002; 23: 502507.
4. Ghai A, Silversides C, Harris L, Webb GD, Siu SC, Therrien J. Left ventricular dysfunction is a risk factor for sudden cardiac death in adults late after repair of tetralogy of Fallot. J Am Coll Cardiol 2002; 40: 16751680.
5. Piotrowski G, Goch A, Wlazlowski R, Gawor Z, Goch JH. Non-invasive methods of atrial function evaluation in heart diseases. Med Sci Monit 2000; 6: 827839.
6. Prioli A, Marino P, Lanzoni L, Zardini P. Increasing degrees of left ventricular filling impairment modulate left atrial function in humans. Am J Cardiol 1998; 82: 756761.
7. Kono T, Sabbah HN, Rosman H, Alam M, Stein PD, Goldstein S. Left atrial contribution to ventricular filling during the course of evolving heart failure. Circulation 1992; 86: 13171322.
8. Hui W, Abd El Rahman MY, Dsebissowa F, et al. Quantitative analysis of right atrial performance after surgical repair of tetralogy of Fallot. Cardiol Young 2004; 14: 520526.
9. Riesenkampff E, Mengelkamp L, Mueller M, et al. Integrated analysis of atrioventricular interactions in tetralogy of Fallot. Am J Physiol Heart Circ Physiol 2010; 299: H364H371.
10. Luijnenburg SE, Peters RE, van der Geest RJ, et al. Abnormal right atrial and right ventricular diastolic function relate to impaired clinical condition in patients operated for tetralogy of Fallot. Int J Cardiol 2013; 167: 833839.
11. Aune E, Baekkevar M, Roislien J, Rodevand O, Otterstad JE. Normal reference ranges for left and right atrial volume indexes and ejection fractions obtained with real-time three-dimensional echocardiography. Eur J Echocardiogr 2009; 10: 738744.
12. Cameli M, Lisi M, Focardi M, et al. Left atrial deformation analysis by speckle tracking echocardiography for prediction of cardiovascular outcomes. Am J Cardiol 2004; 110: 264269.
13. Mueller M, Rentzsch A, Hoetzer K, et al. Assessment of interventricular and right-intraventricular dyssynchrony in patients with surgically repaired tetralogy of Fallot by two-dimensional speckle tracking. Eur J Echocardiogr, 11: 786792.
14. Hatle L. Noninvasive assessment of valve lesions with Doppler ultrasound. Herz 1984; 9: 213221.
15. Gatzoulis MA, Clark AL, Cullen S, Newman CG, Redington AN. Right ventricular diastolic function 15 to 35 years after repair of tetralogy of Fallot. Restrictive physiology predicts superior exercise performance. Circulation 1995; 91: 17751781.
16. Cameli M, Lisi M, Righini FM, Mondillo S. Novel echocardiographic techniques to assess left atrial size, anatomy and function. Cardiovasc Ultrasound 2012; 10: 4.
17. Seguela PE, Hascoet S, Brierre G, Bongard V, Acar P. Feasibility of three-dimensional transthoracic echocardiography to evaluate right ventricular volumes in children and comparison to left ventricular values. Echocardiography 2011; 29: 492501.
18. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307310.
19. Hausdorf G, Hinrichs C, Nienaber CA, Schark C, Keck EW. Left ventricular contractile state after surgical correction of tetralogy of Fallot: risk factors for late left ventricular dysfunction. Pediatr Cardiol 1990; 11: 6168.
20. Krymsky LD. Pathologic anatomy of congenital heart disease. Circulation 1965; 32: 814827.
21. Lange PE, Onnasch DG, Bernhard A, Heintzen PH. Left and right ventricular adaptation to right ventricular overload before and after surgical repair of tetralogy of Fallot. Am J Cardiol 1982; 50: 786794.
22. Abd El Rahman MY, Hui W, Dsebissowa F, et al. Quantitative analysis of paradoxical interventricular septal motion following corrective surgery of tetralogy of Fallot. Pediatr Cardiol 2005; 26: 379384.
23. Bazaz R, Edelman K, Gulyasy B, Lopez-Candales A. Evidence of robust coupling of atrioventricular mechanical function of the right side of the heart: insights from M-mode analysis of annular motion. Echocardiography 2008; 25: 557561.
24. Abd El Rahman MY, Hui W, Yigitbasi M, et al. Detection of left ventricular asynchrony in patients with right bundle branch block after repair of tetralogy of Fallot using tissue-Doppler imaging-derived strain. J Am Coll Cardiol 2005; 45: 915921.
25. Lam YY, Kaya MG, Goktekin O, Gatzoulis MA, Li W, Henein MY. Restrictive right ventricular physiology: its presence and symptomatic contribution in patients with pulmonary valvular stenosis. J Am Coll Cardiol 2007; 50: 14911497.
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Cardiology in the Young
  • ISSN: 1047-9511
  • EISSN: 1467-1107
  • URL: /core/journals/cardiology-in-the-young
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