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


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.


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


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.


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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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