Pediatric Cardiology

, Volume 34, Issue 8, pp 1848–1853 | Cite as

Regional Analysis of Longitudinal Systolic Function of the Right Ventricle After Corrective Surgery of Tetralogy of Fallot Using Myocardial Isovolumetric Acceleration Index

  • Mohamed Y. Abd El Rahman
  • Wei Hui
  • Rita Schuck
  • Axel Rentzsch
  • Felix Berger
  • M. Gutberlet
  • Hashim Abdul-Khaliq
Original Article


To assess regional longitudinal systolic function of the right ventricle in patients with repaired tetralogy of Fallot (TOF) by tissue Doppler imaging-derived isovolumetric acceleration (IVA) index and determine the effect of right-ventricular (RV) enlargement on regional systolic function. In 30 consecutive TOF patients and 30 age-matched controls, myocardial velocity of the RV ventricular free wall in the basal and middle regions were examined in the apical four-chamber view. Peak myocardial velocity during IVA was recorded on the free RV wall. IVA index was calculated as the difference between baseline and peak velocity divided by their time interval. In 23 of the studied TOF patients, magnetic resonance imaging was performed on the same day to determine global RV volume and ejection fraction. IVA index of the RV lateral free wall was significantly lower in the basal (8.31 ± 6.00 vs. 19.00 ± 10.85 m/s2, p = 0.0001) and middle segments (6.56 ± 5.22 vs. 16.17 ± 7.44 m/s2, p = 0.0001) in patients than in controls. Among TOF patients, a negative correlation was found between IVA index in the middle segment and RV end-diastolic volume/body surface area (r = −0.549, p < 0.01). Similar to other longitudinal RV wall parameters, the IVA index showed a decreased value in the RV free wall, which is related to the impaired regional and global longitudinal RV systolic dysfunction. RV enlargement adversely affects regional longitudinal systolic function.


Tetralogy of Fallot  Right-ventricular function  Tissue Doppler imaging  Isovolumetric acceleration index  Magnetic resonance imaging 



This work was supported by the Competence Network for Congenital Heart Defects funded by the Federal Ministry of Education and Research.


  1. 1.
    Alvarez L, Aranega A, Contreras JA, Lopez-Torres J, Fernandez JE (1988) Morphometric study of right ventricle in 32 cases of tetralogy of Fallot. Herz 13:41–48PubMedGoogle Scholar
  2. 2.
    Bashore TM (2007) Adult congenital heart disease: right ventricular outflow tract lesions. Circulation 115:1933–1947CrossRefPubMedGoogle Scholar
  3. 3.
    Eidem BW, O’Leary PW, Tei C, Seward JB (2000) Usefulness of the myocardial performance index for assessing right ventricular function in congenital heart disease. Am J Cardiol 86:654–658CrossRefPubMedGoogle Scholar
  4. 4.
    Goldberg SJ, Allen HD (1985) Quantitative assessment by Doppler echocardiography of pulmonary or aortic regurgitation. Am J Cardiol 56:131–135CrossRefPubMedGoogle Scholar
  5. 5.
    Helbing WA, Bosch HG, Maliepaard C, Rebergen SA, van der Geest RJ, Hansen B et al (1995) Comparison of echocardiographic methods with magnetic resonance imaging for assessment of right ventricular function in children. Am J Cardiol 76:589–594CrossRefPubMedGoogle Scholar
  6. 6.
    Ilbawi MN, Lockhart CG, Idriss FS, DeLeon SY, Muster AJ, Duffy CE et al (1987) Experience with St. Jude Medical valve prosthesis in children. A word of caution regarding right-sided placement. J Thorac Cardiovasc Surg 93:73–79PubMedGoogle Scholar
  7. 7.
    Ilbawi MN, Idriss FS, DeLeon SY, Muster AJ, Gidding SS, Berry TE et al (1987) Factors that exaggerate the deleterious effects of pulmonary insufficiency on the right ventricle after tetralogy repair. Surgical implications. J Thorac Cardiovasc Surg 93:36–44PubMedGoogle Scholar
  8. 8.
    Kavey RE, Bove EL, Byrum CJ, Blackman MS, Sondheimer HM (1987) Postoperative functional assessment of a modified surgical approach to repair of tetralogy of Fallot. J Thorac Cardiovasc Surg 93:533–538PubMedGoogle Scholar
  9. 9.
    Krymsky LD (1965) Pathologic anatomy of congenital heart disease. Circulation 32:814–827CrossRefPubMedGoogle Scholar
  10. 10.
    Lange PE, Onnasch DG, Bernhard A, Heintzen PH (1982) Left and right ventricular adaptation to right ventricular overload before and after surgical repair of tetralogy of Fallot. Am J Cardiol 50:786–794CrossRefPubMedGoogle Scholar
  11. 11.
    Lillehei CW, Varco RL, Cohen M, Warden HE, Patton C, Moller JH (1986) The first open-heart repairs of ventricular septal defect, atrioventricular communis, and tetralogy of Fallot using extracorporeal circulation by cross-circulation: a 30-year follow-up. Ann Thorac Surg 41:4–21CrossRefPubMedGoogle Scholar
  12. 12.
    Luijnenburg SE, Peters RE, van der Geest RJ, Moelker A, Roos-Hesselink JW, de Rijke et al. (2012) Abnormal right atrial and right ventricular diastolic function relate to impaired clinical condition in patients operated for tetralogy of Fallot. Int J Cardiol 158:359–63Google Scholar
  13. 13.
    Oki T, Fukuda K, Tabata T, Mishiro Y, Yamada H, Abe M et al (1999) Effect of an acute increase in afterload on left ventricular regional wall motion velocity in healthy subjects. J Am Soc Echocardiogr 12:476–483CrossRefPubMedGoogle Scholar
  14. 14.
    Riesenkampff E, Mengelkamp L, Mueller M, Kropf S, Abdul-Khaliq H, Sarikouch S et al (2010) Integrated analysis of atrioventricular interactions in tetralogy of Fallot. Am J Physiol Heart Circ Physiol 299:H364–H371PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Sanchez-Quintana D, Anderson RH, Ho SY (1996) Ventricular myoarchitecture in tetralogy of Fallot. Heart 76:280–286PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Seguela P, Hascoet ES, Brierre G, Bongard V, Acar P (2011) Feasibility of three-dimensional transthoracic echocardiography to evaluate right ventricular volumes in children and comparison to left ventricular values. Echocardiography 29:492–501CrossRefPubMedGoogle Scholar
  17. 17.
    Vogel M, Gutberlet M, Dittrich S, Hosten N, Lange PE (1997) Comparison of transthoracic three dimensional echocardiography with magnetic resonance imaging in the assessment of right ventricular volume and mass. Heart 78:127–130PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    Vogel M, Sponring J, Cullen S, Deanfield JE, Redington AN (2001) Regional wall motion and abnormalities of electrical depolarization and repolarization in patients after surgical repair of tetralogy of Fallot. Circulation 103:1669–1673CrossRefPubMedGoogle Scholar
  19. 19.
    Vogel M, Schmidt MR, Kristiansen SB, Cheung M, White PA, Sorensen K et al (2002) Validation of myocardial acceleration during isovolumic contraction as a novel noninvasive index of right ventricular contractility: comparison with ventricular pressure–volume relations in an animal model. Circulation 105:1693–1699CrossRefPubMedGoogle Scholar
  20. 20.
    Weidemann F, Eyskens B, Sutherland GR (2002) New ultrasound methods to quantify regional myocardial function in children with heart disease. Pediatr Cardiol 23:292–306CrossRefPubMedGoogle Scholar
  21. 21.
    Weidemann F, Eyskens B, Jamal F, Mertens L, Kowalski M, D’Hooge J et al (2002) Quantification of regional left and right ventricular radial and longitudinal function in healthy children using ultrasound-based strain rate and strain imaging. J Am Soc Echocardiogr 15:20–28CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Mohamed Y. Abd El Rahman
    • 1
    • 3
    • 4
  • Wei Hui
    • 1
    • 2
  • Rita Schuck
    • 1
  • Axel Rentzsch
    • 3
  • Felix Berger
    • 1
  • M. Gutberlet
    • 5
    • 6
  • Hashim Abdul-Khaliq
    • 1
    • 3
  1. 1.Department of Congenital Heart DiseaseDeutsches HerzzentrumBerlinGermany
  2. 2.Labatt Family Heart CentreThe Hospital for Sick Children, University of TorontoTorontoCanada
  3. 3.Department of Pediatric CardiologySaarland University HospitalHomburg/SaarGermany
  4. 4.Department of Pediatrics and Pediatric CardiologyCairo UniversityCairoEgypt
  5. 5.Department of Radiology and Nuclear MedicineCharite Campus Virchow KlinikumBerlinGermany
  6. 6.Department of Diagnostic and Interventional RadiologyUniversity of Leipzig-Heart CenterLeipzigGermany

Personalised recommendations