Pediatric Cardiology

, Volume 39, Issue 4, pp 731–742 | Cite as

Flow Energy Loss as a Predictive Parameter for Right Ventricular Deterioration Caused by Pulmonary Regurgitation After Tetralogy of Fallot Repair

  • Miyuki Shibata
  • Keiichi ItataniEmail author
  • Taiyu Hayashi
  • Takashi Honda
  • Atsushi Kitagawa
  • Kagami Miyaji
  • Minoru Ono
Original Article


The optimal timing for pulmonary valve replacement after Tetralogy of Fallot (TOF) repair remains controversial. In this study, we estimated the feasibility of using flow energy loss (FEL) to predict right ventricular (RV) deterioration due to pulmonary regurgitation after TOF repair. We examined RV outflow tract (RVOT) flow in nine patients who underwent TOF or double-outlet right ventricle repair in the intervention group (Group I) and compared them with three healthy children in the control group (Group C). We evaluated flow across the RVOT and pulmonary valve by vector flow mapping (VFM) on echocardiography and by phase contrast-magnetic resonance imaging (PC-MRI). Next, we calculated FEL and analyzed the relationship between FEL and clinical parameters of RV function. The mean FEL was significantly greater in Group I than in Group C (p = 0.002). Flow pattern and FEL were comparable by VFM and PC-MRI at the same phase 14.6 years after TOF repair. There was a significant positive correlation for the cardiothoracic ratio with both the mean FEL [correlation coefficient (r) = 0.78; p = 0.012] and the diastolic peak FEL (r = 0.75; p = 0.021) in Group I. There was also a significant positive correlation between the serial change in QRS duration with both the mean FEL (r = 0.82; p = 0.014) and the diastolic FEL (r = 0.70; p = 0.052) in Group I. FEL by VFM is an effective tool for evaluating ventricular deterioration caused by RV workload.


Tetralogy of Fallot Pulmonary regurgitation Right ventricular deterioration Vector flow mapping Flow energy loss 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest with respect to this manuscript.

Informed Consent

Informed consent was obtained from all individual participants included in this study.


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Copyright information

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

Authors and Affiliations

  • Miyuki Shibata
    • 1
  • Keiichi Itatani
    • 1
    • 2
    Email author
  • Taiyu Hayashi
    • 3
  • Takashi Honda
    • 4
  • Atsushi Kitagawa
    • 4
  • Kagami Miyaji
    • 5
  • Minoru Ono
    • 1
  1. 1.Department of Cardiac SurgeryThe University of TokyoTokyoJapan
  2. 2.Department of Cardiovascular SurgeryKyoto Prefectural University of MedicineKyotoJapan
  3. 3.Department of CardiologyNational Center for Child Health and DevelopmentTokyoJapan
  4. 4.Department of PediatricsKitasato University School of MedicineSagamiharaJapan
  5. 5.Department of Cardiovascular SurgeryKitasato University School of MedicineSagamiharaJapan

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