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Pediatric Cardiology

, Volume 39, Issue 7, pp 1373–1377 | Cite as

Short-Axis Diastolic Ventricular Area Ratio as a New Index in Screening Patients with Repaired Tetralogy of Fallot

  • Dala Zakaria
  • Sean Lang
  • Mallikarjuna Rettiganti
  • Jeffrey M. Gossett
  • Elijah Bolin
  • R. Thomas Collins
Original Article

Abstract

Right ventricular (RV) end-diastolic volume measured by cardiovascular magnetic resonance imaging (CMR) is a criterion for pulmonary valve replacement in patients with tetralogy of Fallot (TOF). We sought to determine if the ratio of echocardiographic, short-axis RV-to-left ventricular (LV) end-diastolic areas (EDA) could be used to predict RV volume on CMR. We retrospectively reviewed the echocardiograms of all patients with repaired TOF who underwent CMR at our institution from 2011 to 2015 and also had an echocardiogram within 6 months of the CMR. The short-axis RV and LV EDAs were measured and the ratio of the two was calculated. Results were compared with CMR RV end-diastolic volume index (RVEDVi) and RV:LV end-diastolic volume ratio. The sensitivity and specificity values predicting RV volumes > 150 ml/m2 were calculated. Fifty-eight studies met inclusion criteria. There were 47 studies with RVEDVi < 150 ml/m2 and 11 with RVEDVi > 150 ml/m2. RV:LV EDA and CMR RV:LV end-diastolic volume ratio correlated strongly (r = 0.76, p < 0.0001). An RV:LV EDA ≥ 1.57 had a 90% sensitivity to predict RVEDVi > 150 ml/m2 (area under the curve = 0.74, 95% CI 1.5–27.9; p = 0.012). An RV:LV EDA ≥ 1.88 had an 81% specificity to detect RV volume index > 150 ml/m2. Short-axis RV:LV EDA correlates well with an increased RVEDVi as measured by CMR. This new and simple measure can be used to predict optimal timing for CMR in anticipation of pulmonary valve replacement in repaired TOF.

Keywords

Tetralogy of Fallot Magnetic resonance imaging Echocardiogram Right ventricular area Right ventricle Screening 

Notes

Author Contributions

DZ: concept and project design, data collection, interpretation, drafting manuscript. SL: data collection, editing manuscript. MR and JMG: statistics. EB: reviewing and editing manuscript. TC: interpretation, revision of manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This manuscript does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    Rudski LG, Lai WW, Afilalo J et al (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23:685–713CrossRefGoogle Scholar
  2. 2.
    Lai WW, Gauvreau K, Rivera ES et al (2008) Accuracy of guideline recommendations for two-dimensional quantification of the right ventricle by echocardiography. Int J Cardiovasc Imaging 24:691–698CrossRefGoogle Scholar
  3. 3.
    Knauth AL, Gauvreau K, Powell AJ et al (2008) Ventricular size and function assessed by cardiac MRI predict major adverse clinical outcomes late after tetralogy of Fallot repair. Heart 94:211–216CrossRefGoogle Scholar
  4. 4.
    Schamberger MS, Hurwitz RA (2000) Course of right and left ventricular function in patients with pulmonary insufficiency after repair of Tetralogy of Fallot. Pediatr Cardiol 21:244–248CrossRefGoogle Scholar
  5. 5.
    Harrison DA, Harris L, Siu SC et al (1997) Sustained ventricular tachycardia in adult patients late after repair of tetralogy of Fallot. J Am Coll Cardiol 30:1368–1373CrossRefGoogle Scholar
  6. 6.
    Therrien J, Siu SC, McLaughlin PR et al (2000) Pulmonary valve replacement in adults late after repair of tetralogy of fallot: are we operating too late? J Am Coll Cardiol 36:1670–1675CrossRefGoogle Scholar
  7. 7.
    Therrien J, Provost Y, Merchant N et al (2005) Optimal timing for pulmonary valve replacement in adults after tetralogy of Fallot repair. Am J Cardiol 95:779–782CrossRefGoogle Scholar
  8. 8.
    Geva T (2013) Indications for pulmonary valve replacement in repaired tetralogy of fallot: the quest continues. Circulation 17:1855–1857CrossRefGoogle Scholar
  9. 9.
    Warnes CA, Williams RG, Bashore TM et al (2008) ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: executive summary. A report of the American college of cardiology/American heart association task force on practice guidelines (writing committee to develop guidelines for the management of adults with congenital heart disease): developed in collaboration with the American society of echocardiography, Heart rhythm society, International society for adult congenital heart disease, Society for cardiovascular angiography and interventions, and society of thoracic surgeons. Circulation 118:2395–2451CrossRefGoogle Scholar
  10. 10.
    Tweddell JS, Simpson P, Li SH et al (2012) Timing and technique of pulmonary valve replacement in the patient with tetralogy of Fallot. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 15:27–33CrossRefGoogle Scholar
  11. 11.
    Punn R, Behzadian F, Tacy TA (2010) Annular tilt as a screening test for right ventricular enlargement in patients with tetralogy of Fallot. J Am Soc Echocardiogr 23:1297–1302CrossRefGoogle Scholar
  12. 12.
    Geva T (2011) Repaired tetralogy of Fallot: the roles of cardiovascular magnetic resonance in evaluating pathophysiology and for pulmonary valve replacement decision support. J Cardiovasc Magn Reson 13:9CrossRefGoogle Scholar
  13. 13.
    Pennell DJ, Sechtem UP, Higgins CB et al (2004) Clinical indications for cardiovascular magnetic resonance (CMR): consensus panel report. J Cardiovasc Magn Reson 6:727–765CrossRefGoogle Scholar
  14. 14.
    Pohost GM, Hung L, Doyle M (2003) Clinical use of cardiovascular magnetic resonance. Circulation 108:647–653CrossRefGoogle Scholar
  15. 15.
    Alghamdi MH, Grosse-Wortmann L, Ahmad N, Mertens L et al (2012) Can simple echocardiographic measures reduce the number of cardiac magnetic resonance imaging studies to diagnose right ventricular enlargement in congenital heart disease? J Am Soc Echocardiogr 25:518–523CrossRefGoogle Scholar
  16. 16.
    Greutmann M, Tobler D, Biaggi P et al (2010) Echocardiography for assessment of right ventricular volumes revisited: a cardiac magnetic resonance comparison study in adults with repaired tetralogy of Fallot. J Am Soc Echocardiogr 23:905–911CrossRefGoogle Scholar
  17. 17.
    Cavalcanti PE, Sá MP, Santos CA et al (2013) Pulmonary valve replacement after operative repair of tetralogy of Fallot: meta-analysis and meta-regression of 3,118 patients from 48 studies. J Am Coll Cardiol 62:2227–2243CrossRefGoogle Scholar
  18. 18.
    Oosterhof T, Van Straten A, Vliegen HW et al (2007) Preoperative thresholds for pulmonary valve replacement in patients with corrected tetralogy of Fallot using cardiovascular magnetic resonance. Circulation 116:545–551CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Pediatric Cardiology, Department of PediatricsUniversity of Arkansas for Medical Sciences and Arkansas Children’s Research InstituteLittle RockUSA
  2. 2.Biostatistics Program, Department of PediatricsUniversity of Arkansas for Medical Sciences and Arkansas Children’s Research InstituteLittle RockUSA

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