Pediatric Cardiology

, Volume 34, Issue 4, pp 948–953 | Cite as

Altered Diastolic Left Atrial and Ventricular Performance in Asymptomatic Patients After Repair of Tetralogy of Fallot

  • Karsten Koenigstein
  • Tanja Raedle-Hurst
  • Meryem Hosse
  • Maxi Hauser
  • Hashim Abdul-Khaliq
Original Article

Abstract

We evaluated the interaction of left atrial and ventricular diastolic performance in asymptomatic children and young adults after ToF-repair (n=25). Those young people, as well as 25 age matched healthy children and young adults were examined using non-invasive conventional echocardiography. Regional systolic and diastolic myocardial strain and strain rate in left atrium and ventricle were analysed using 2D-speckle-tracking (Vivid VII, EchoPacGE). We collected planimetric data about the left atrial and ventricular performance during systole (volumetric LVEF, LV-Tei-Index, MV-E/E'-Ratio) and diastole (LAEF, LVEDV, left atrial volume). Registration of right pulmonary-venous inflow-patterns during ventricular systole, diastole and active atrial contraction was used to support assessment of left atrial function. To verify the timing of left atrial contraction and possible electromechanical delay we measured several ECG-related time-intervals. Statistical analysis included Mann-Whitney-U-Test, Bonferroni-Holm-Test and two-tailed Spearman-Correlation. Systolic pulmonary-venous inflow in ToF-patients was not different compared to the controls. Early diastolic pulmonary-venous inflow was significantly higher in ToF-patients as well as the LV-Tei-Index. The MV-E/E'-ratio, which is closely related to LVEDP, was significantly higher in ToF-patients and correlated with the early diastolic pulmonary venous inflow parameters such as the maximum diastolic bloodflow speed. Diastolic left atrial and ventricular strain and strain rate in ToF-patients did not differ from those in the controls. During late diastole there was a significantly premature timing of maximum myocardial strain rate of the interatrial septum and time-ratio of P-wave origin to maximum reverse pulmonary-venous blood flow and the duration of one heart action. Furthermore the maximum late diastolic reverse pulmonary-venous blood flow was significantly higher in ToF-patients. Those observations indicate a premature active left atrial contraction in late diastole in ToF-patients compared to the controls. In asymptomatic young patients after ToF-repair earlier and increased left atrial contraction was found, which may indicate adaptive compensatory mechanisms to overcome latent and asymptomatic altered systolic and diastolic left ventricular performance. Extensive assessment of left atrial parameters including the pulmonary veins should be considered in terms of an entire evaluation of left heart function in patients after ToF-repair.

Keywords

Tetralogy of Fallot Diastolic dysfunction Left atrium Left ventricle Echocardiography 2D speckle tracking 

Notes

Acknowledgments

This work was supported by the Kompetenznetz Angeborene Herzfehler (Competence Network for Congenital Heart Defects) funded by the Federal Ministry of Education and Research (Grant No. FKZ 01G10210).

References

  1. 1.
    Abd El Rahman MY, Abdul-Khaliq H, Vogel M, Alexi-Meskishvili V, Gutberlet M, Lange PE (2000) Relation between right-ventricular enlargement, QRS duration and right-ventricular function in patients with tetralogy of Fallot and pulmonary regurgitation after surgical repair. Heart 84:416–420PubMedCrossRefGoogle Scholar
  2. 2.
    Abd El Rahman MY, Hui W, Timme J, Ewert P, Berger F, Dsebissowa F et al (2005) Analysis of atrial and ventricular performance by tissue Doppler imaging in patients with atrial septal defects before and after surgical and catheter closure. Echocardiography (Mount Kisco, NY) 22:579–585CrossRefGoogle Scholar
  3. 3.
    Abd El Rahman M, Hui W, Yigtibasi M et al (2005) 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 45:915–921PubMedCrossRefGoogle Scholar
  4. 4.
    Davlouros PA, Kilner PJ, Hornung TS, Li W, Francis JM, Moon JC et al (2002) 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 40:2044–2052PubMedCrossRefGoogle Scholar
  5. 5.
    Dodge HT, Sandler H, Ballew DW, Lord JD (1960) The use of biplane angiocardiography for the measurement of left-ventricular volume in man. Am Heart J 60:762–776PubMedCrossRefGoogle Scholar
  6. 6.
    Gatzoulis MA, Balaji S, Webber SA, Siu SC, Hokanson JS, Poile C et al (2000) Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. Lancet 356:975–981PubMedCrossRefGoogle Scholar
  7. 7.
    Geva T, Sandweiss BM, Gauvreau K, Lock JE, Powel AJ (2004) Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging. J Am Coll Cardiol 43:1068–1074PubMedCrossRefGoogle Scholar
  8. 8.
    Hausdorf G, Hinrichs C, Nienaber CA, Schark C, Keck EW (1990) Left-ventricular contractile state after surgical correction of tetralogy of Fallot: risk factors for late left-ventricular dysfunction. Pediatr Cardiol 11:61–68PubMedCrossRefGoogle Scholar
  9. 9.
    Hui W, Abd El Rahman MY, Dsebissowa F, Rentzsch A, Gutberlet M, Alexi-Mekishvili V et al (2004) Quantitative analysis of right atrial performance after surgical repair of tetralogy of Fallot. Cardiol Young 14:520–526PubMedCrossRefGoogle Scholar
  10. 10.
    Knirsch W, Dodge-Khatami A, Kadner A et al (2008) Assessment of myocardial function in pediatric patients with operated tetralogy of Fallot: preliminary results with 2D strain echocardiography. Pediatr Cardiol 29:718–725PubMedCrossRefGoogle Scholar
  11. 11.
    Lawson MA, Blackwell GG, Davis ND, Roney M, Dell'Italia LJ, Pohost GM (1996) Accuracy of biplane long-axis left-ventricular volume determined by cine magnetic resonance imaging in patients with regional and global dysfunction. Am J Cardiol 77(12):1098–1104PubMedCrossRefGoogle Scholar
  12. 12.
    Mueller M, Rentzsch A, Hoetzer K et al (2010) Assessment of interventricular and right-intraventricular dyssynchrony in patients with surgically repaired tetralogy of Fallot by two-dimensional speckle tracking. Eur J Echocardiogr 11(9):786–792PubMedCrossRefGoogle Scholar
  13. 13.
    Prioli A, Marino P, Lanzoni L, Zardini P (1998) Increasing degrees of left-ventricular filling impairment modulate left atrial function in humans. Am J Cardiol 82:756–761PubMedCrossRefGoogle Scholar
  14. 14.
    Raedle-Hurst TM, Mueller M, Rentzsch A et al (2009) Assessment of left-ventricular dyssynchrony and function using real-time 3-dimensional echocardiography in patients with congenital right heart disease. Am Heart J 157(4):791–798PubMedCrossRefGoogle Scholar
  15. 15.
    Riesenkampff E et al (2010) Integrated analysis of atrio-ventricular interaction in tetralogy of Fallot. Am J Physiol Heart Circ Physiol 299(2):H364–H371PubMedCrossRefGoogle Scholar
  16. 16.
    Spencer KT, Mor-Avi V, Gorcsan Jr 3rd, DeMaria AN, Kimball TR et al (2001) Effects of aging on left atrial reservoir, conduit and booster pump function: a multi-institution acoustic quantification study. Heart (British Cardiac Society) 85:272–277CrossRefGoogle Scholar
  17. 17.
    Støylen A, Heimdal A, Bjornstad K, Torp HG, Skjaerpe T (1999) Strain rate imaging by ultrasound in the diagnosis of regional dysfunction of the left ventricle. Echocardiography 16(4):321–329PubMedCrossRefGoogle Scholar
  18. 18.
    Tzemos N, Harris L, Carasso S, Subira LD, Greutmann M, Provost Y et al (2009) Adverse left-ventricular mechanics in adults with repaired tetralogy of Fallot. Am J Cardiol 103:420–425PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Karsten Koenigstein
    • 1
  • Tanja Raedle-Hurst
    • 1
  • Meryem Hosse
    • 1
  • Maxi Hauser
    • 1
  • Hashim Abdul-Khaliq
    • 1
  1. 1.Clinic for Paediatric CardiologySaarland University HospitalHomburg/SaarGermany

Personalised recommendations