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Sex-Specific Differences in Ventricular Dimensions in Repaired Tetralogy of Fallot: A Retrospective Study

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Abstract

The timing of pulmonary valve replacement (PVR) in asymptomatic patients with repaired tetralogy of Fallot (TOF) is typically based on cardiac magnetic resonance imaging-derived ventricular volume measurements. Current criteria do not account for sex-based differences in chamber size. The purpose of this study was to compare male and female ventricular volumes and function in TOF patients with a hypothesis that females are less likely to meet common-indexed right ventricular end-diastolic volume (RVEDVi) and right ventricular end-systolic volume (RVESVi) criteria for PVR. Cardiac magnetic resonance data from 17 females (age 31.7 ± 15.4 years) and 23 males (30.7 ± 15.4 years) with TOF were retrospectively analyzed. Demographic and imaging data were recorded. Differences in sex-based means and standard deviations were evaluated using the Wilcoxon rank-sum test with continuity correction. Age and pulmonary regurgitant fraction were similar in females and males. RVEDVi was lower in females than in males, but the difference was not statistically significant. Differences in RVESVi, LVEDVi, LVESVi, and left ventricular ejection fraction were statistically significant, while the difference in right ventricular ejection fraction was not. RVEDVi was greater than 150 mL/m2 in 3/17 (17.6%) females and 10/23 (43.5%) males (OR 3.6). RVESVi was greater than 82 mL/m2 in 2/17 females and 8/23 males (OR 4.0). Sex-specific differences in right ventricular and left ventricular volumes and function are present in patients with TOF despite similar pulmonary regurgitation. These differences may need to be considered when evaluating patients for PVR.

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Authors and Affiliations

  1. Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, USA

    Kevin A. Pettit & Heather L. Bartlett

  2. Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, USA

    Christopher J. Francois & Niti R. Aggarwal

  3. Department of Medicine, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave, MC 4108, Madison, WI, 53792, USA

    Niti R. Aggarwal, Timothy M. Hess & Heather L. Bartlett

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  1. Kevin A. Pettit
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  2. Christopher J. Francois
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  4. Timothy M. Hess
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  5. Heather L. Bartlett
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Correspondence to Heather L. Bartlett.

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The authors have no commercial or other associations that might pose a conflict of interest in connection with the submitted article. The authors of this work report no relationships with industry and other entities. The authors declare that they have no conflict of interest.

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This retrospective research was approved by the University of Wisconsin Institutional Review Board, protocol 2016-0418.

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Pettit, K.A., Francois, C.J., Aggarwal, N.R. et al. Sex-Specific Differences in Ventricular Dimensions in Repaired Tetralogy of Fallot: A Retrospective Study. Pediatr Cardiol 40, 1530–1535 (2019). https://doi.org/10.1007/s00246-019-02181-5

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  • DOI: https://doi.org/10.1007/s00246-019-02181-5

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