Hostname: page-component-848d4c4894-75dct Total loading time: 0 Render date: 2024-05-28T18:18:42.524Z Has data issue: false hasContentIssue false
  • English
  • Français

Delayed enhancement imaging in a contemporary patient cohort following correction of tetralogy of Fallot

Published online by Cambridge University Press:  10 November 2014

Uta Preim ,
Philipp Sommer ,
Janine Hoffmann ,
Jana Kehrmann ,
Lukas Lehmkuhl ,
Ingo Daehnert ,
Matthias Gutberlet  and
Matthias Grothoff
Uta Preim*
Affiliation:
Department of Radiology, University of Leipzig – Heart Center, Leipzig, Germany
Philipp Sommer
Affiliation:
Department of Electrophysiology, University of Leipzig – Heart Center, Leipzig, Germany
Janine Hoffmann
Affiliation:
Department of Radiology, University of Leipzig – Heart Center, Leipzig, Germany
Jana Kehrmann
Affiliation:
Department of Radiology, University of Leipzig – Heart Center, Leipzig, Germany
Lukas Lehmkuhl
Affiliation:
Department of Radiology, University of Leipzig – Heart Center, Leipzig, Germany
Ingo Daehnert
Affiliation:
Department of Congenital Heart Disease/Pediatric Cardiology, University of Leipzig – Heart Center, Leipzig, Germany
Matthias Gutberlet
Affiliation:
Department of Radiology, University of Leipzig – Heart Center, Leipzig, Germany
Matthias Grothoff
Affiliation:
Department of Radiology, University of Leipzig – Heart Center, Leipzig, Germany
*
Correspondence to: Dr U. Preim, MD, Department of Radiology, University of Leipzig – Heart Center, Struempellstr. 39, 04289 Leipzig, Germany. Tel: 0341 865 1702; Fax: 0341 865 1803; E-mail: uta.preim@googlemail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

To test the hypothesis that myocardial scars after repair of tetralogy of Fallot are related to impaired cardiac function and adverse clinical outcome.

Methods

A total of 53 patients were retrospectively analysed after repair of tetralogy of Fallot. The median patient age was 20 years (range 2–48).

Cardiac MRI with a 1.5 T magnet included cine sequences to obtain volumes and function, phase-sensitive inversion recovery delayed enhancement imaging to detect myocardial scars, and flow measurements to determine pulmonary regurgitation fraction. In addition, clinical parameters were obtained.

Results

An overall 83% of patients were in NYHA class I. All patients with the exception of 2 (96%) had pulmonary insufficiency. Mean ejection fraction and end-diastolic volume index were 46% and 128 ml/m2 for the right ventricle and 54% and 82 ml/m2 for the left ventricle, respectively. Excluding enhancement of the septal insertion and prosthetic patches, delayed enhancement was seen in 11/53 cases (21%). Delayed enhancement of the right ventricle was detected in 6/53 patients (11%) and of the left ventricle in 5/53 patients (9%). The patient group with delayed enhancement was significantly older (p=0.003), had later repair (p=0.007), and higher left ventricular myocardial mass index (p=0.009) compared with the group without delayed enhancement.

Conclusions

This study reveals that scarring is common in patients after surgical repair of tetralogy of Fallot and is associated with older age and late repair. However, there was no difference in right ventricular function, NYHA class, or occurrence of clinically relevant arrhythmias between patients with and those without myocardial scars.

Keywords

Cardiac magnetic resonancedelayed enhancement imagingtetralogy of Fallotright ventricular function
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 7 , October 2015 , pp. 1268 - 1275
Check for updates
Copyright
© Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

The first two authors contributed equally to this work

**

The last two authors should be considered as senior authors.

References

1. 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: 593–599.Google Scholar
2. Vliegen, HW, van Straten, A, de Roos, A, et al. Magnetic resonance imaging to assess the hemodynamic effects of pulmonary valve replacement in adults late after repair of tetralogy of Fallot. Circulation 2002; 106: 1703–1707.Google Scholar
3. Davlouros, PA, Kilner, PJ, Hornung, TS, et al. Right ventricular function in adults with repaired tetralogy of Fallot assessed with cardiovascular magnetic resonance imaging: detrimental role of right ventricular outflow aneurysms or akinesia and adverse right-to-left ventricular interaction. J Am Coll Cardiol 2002; 40: 2044–2052.Google Scholar
4. Fox, D, Devendra, GP, Hart, SA, Krasuski, RA. When ‘blue babies’ grow up: what you need to know about tetralogy of Fallot. Cleve Clin J Med 2010; 77: 821–828.Google Scholar
5. Eyskens, B, Reybrouck, T, Bogaert, J, et al. Homograft insertion for pulmonary regurgitation after repair of tetralogy of Fallot improves cardiorespiratory exercise performance. Am J Cardiol 2000; 85: 221–225.CrossRefGoogle ScholarPubMed
6. Yemets, IM, Williams, WG, Webb, GD, et al. Pulmonary valve replacement late after repair of tetralogy of Fallot. Ann Thorac Surg 1997; 64: 526–530.Google Scholar
7. d’Udekem, Y, Rubay, J, Shango-Lody, P, et al. Late homograft valve insertion after transannular patch repair of tetralogy of Fallot. J Heart Valve Dis 1998; 7: 450–454.Google Scholar
8. Therrien, J, Siu, SC, Harris, L, et al. Impact of pulmonary valve replacement on arrhythmia propensity late after repair of tetralogy of Fallot. Circulation 2001; 103: 2489–2494.Google Scholar
9. Discigil, B, Dearani, JA, Puga, FJ, et al. Late pulmonary valve replacement after repair of tetralogy of Fallot. J Thorac Cardiovasc Surg 2001; 121: 344–515.Google Scholar
10. Babu-Narayan, SV, Kilner, PJ, Li, W, et al. Ventricular fibrosis suggested by cardiovascular magnetic resonance in adults with repaired tetralogy of Fallot and its relationship to adverse markers of clinical outcome. Circulation 2006; 113: 405–413.CrossRefGoogle ScholarPubMed
11. Deanfield, JE, Ho, SY, Anderson, RH, McKenna, WJ, Allwork, SP, Hallidie-Smith, KA. Late sudden death after repair of tetralogy of Fallot: a clinicopathologic study. Circulation 1983; 67: 626–631.Google Scholar
12. Jones, M, Ferrans, VJ. Myocardial degeneration in congenital heart disease. Comparison of morphologic findings in young and old patients with congenital heart disease associated with muscular obstruction to right ventricular outflow. Am J Cardiol 1977; 39: 1051–1063.Google Scholar
13. Garson, A. Ventricular dysrhythmias after congenital heart surgery: a canine model. Pediatr Res 1984; 18: 1112–1120.Google Scholar
14. Plaisier, AS, Burgmans, MC, Vonken, EP, et al. Image quality assessment of the right ventricle with three different delayed enhancement sequences in patients suspected of ARVC/D. Int J Cardiovasc Imaging 2011; 28: 505–601.Google Scholar
15. Preim, U, Hoffmann, J, Lehmkuhl, L, et al. Systemic right ventricles rarely show myocardial scars in cardiac magnetic resonance delayed-enhancement imaging. Clin Res Cardiol 2013; 102: 337–344.Google Scholar
16. Grothoff, M, Elpert, C, Hoffmann, J, et al. Right ventricular injury in ST-elevation myocardial infarction: risk stratification by visualization of wall motion, edema, and delayed-enhancement cardiac magnetic resonance. Circ Cardiovasc Imaging 2012; 5: 60–68.Google Scholar
17. Winter, MM, Bernink, FJ, Groenink, M, et al. Evaluating the systemic right ventricle by CMR: the importance of consistent and reproducible delineation of the cavity. J Cardiovasc Magn Reson 2008; 10: 40.Google Scholar
18. Bondarenko, O, Beek, AM, Hofman, MB, et al. Standardizing the definition of hyperenhancement in the quantitative assessment of infarct size and myocardial viability using delayed contrast-enhanced CMR. J Cardiovasc Magn Reson 2005; 7: 481–485.Google Scholar
19. Cerqueira, MD, Weissman, NJ, Dilsizian, V, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the cardiac imaging committee of the council on clinical cardiology of the American Heart Association. Circulation 2002; 105: 539–542.Google Scholar
20. Huber, AM, Schoenberg, SO, Hayes, C, et al. Phase-sensitive inversion-recovery MR imaging in the detection of myocardial infarction. Radiology 2005; 237: 854–860.Google Scholar
21. Kellman, P, Arai, AE, McVeigh, ER, Aletras, AH. Phase-sensitive inversion recovery for detecting myocardial infarction using gadolinium-delayed hyperenhancement. Magn Reson Med 2002; 47: 372–383.Google Scholar
22. 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: 1775–1781.Google Scholar
23 Moon, JC, McKenna, WJ, McCrohon, JA, Elliott, PM, Smith, GC, Pennell, DJ. Toward clinical risk assessment in hypertrophic cardiomyopathy with gadolinium cardiovascular magnetic resonance. J Am Coll Cardiol 2003; 41: 1561–1567.Google Scholar
24. Gatzoulis, MA, Till, JA, Somerville, J, Redington, AN. Mechanoelectrical interaction in tetralogy of Fallot. QRS prolongation relates to right ventricular size and predicts malignant ventricular arrhythmias and sudden death. Circulation 1995; 92: 231–237.CrossRefGoogle ScholarPubMed
25. Downar, E, Harris, L, Kimber, S, et al. Ventricular tachycardia after surgical repair of tetralogy of Fallot: results of intraoperative mapping studies. J Am Coll Cardiol 1992; 20: 648–655.Google Scholar
26. Cullen, S, Celermajer, DS, Franklin, RC, Hallidie-Smith, KA, Deanfield, JE. Prognostic significance of ventricular arrhythmia after repair of tetralogy of Fallot: a 12-year prospective study. J Am Coll Cardiol 1994; 23: 1151–1155.Google Scholar
27. Norgård, G, Gatzoulis, MA, Moraes, F, et al. Relationship between type of outflow tract repair and postoperative right ventricular diastolic physiology in tetralogy of Fallot. Implications for long-term outcome. Circulation 1996; 94: 3276–3280.Google Scholar
28. Grothoff, M, Hoffmann, J, Lehmkuhl, L, et al. Time course of right ventricular functional parameters after surgical correction of tetralogy of Fallot determined by cardiac magnetic resonance. Clin Res Cardiol 2011; 100: 343–350.Google Scholar