Abstract
The global myocardial function in patients after repair of tetralogy of Fallot (TOF) can be assessed by cardiovascular magnetic resonance (CMR) and measurement of B-type natriuretic peptides. Two-dimensional echocardiography-derived strain and strain rate (2D strain) facilitate the assessment of regional myocardial function. We evaluated myocardial function in 16 children with residual severe pulmonary valve regurgitation and right ventricular (RV) volume overload after TOF repair before, 1 month after, and 6 months after pulmonary valve replacement (PVR). In 2D strain echocardiography preoperatively, the longitudinal systolic RV strain was reduced (p < 0.05). One month after PVR, longitudinal systolic RV strain decreased further (p < 0.05), while systolic and early diastolic radial left ventricular strain and strain rate increased (each p < 0.05), followed by a return toward preoperative values after 6 months. Six months after PVR, preoperatively elevated RV end-diastolic volume (p < 0.01) assessed by CMR and N-terminal pro-B-type natriuretic peptide (p < 0.05) decreased. In conclusion, the impairment of the regional myocardial after TOF repair and transient changes after PVR can be subtly analyzed by 2D strain echocardiography in addition to the established assessment of myocardial function with CMR and measurement of B-type natriuretic peptides.
Similar content being viewed by others
References
Brili S, Alexopoulos N, Latsios G, Aggeli C, Barbetseas J, Pitsavos C, Vyssoulis G, Stefanidis C (2005) Tissue doppler imaging and brain natriuretic peptide levels in adults with repaired tetralogy of Fallot. J Am Soc Echocardiogr 18:1149–1154
Coats L, Khambadkone S, Derrick G, Sridharan S, Schievano S, Mist B, Jones R, Deanfield JE, Pellerin D, Bonhoeffer P, Taylor AM (2006) Physiological and clinical consequences of relief of right ventricular outflow tract obstruction late after repair of congenital heart defects. Circulation 113:2037–2044
Coats L, Khambadkone S, Derrick G, Hughes M, Jones R, Mist B, Pellerin D, Marek J, Deanfield JE, Bonhoeffer P, Taylor AM (2007) Physiological consequences of percutaneous pulmonary valve implantation: the different behaviour of volume- and pressure-overloaded ventricles. Eur Heart J 28:1886–1893
Davlouros PA, Kilner PJ, Hornung TS, Li W, Francis JM, Moon JC, Smith GC, Tat T, Pennell DJ, Gatzoulis MA (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 40:2044–2052
Delfino JG, Bhasin M, Cole R, Eisner RL, Merlino J, Leon AR, Oshinski JN (2006) Comparison of myocardial velocities obtained with magnetic resonance phase velocity mapping and tissue Doppler imaging in normal subjects and patients with left ventricular dyssynchrony. J Magn Reson Imaging 24:304–311
Gatzoulis MA, Balaji S, Webber SA, Siu SC, Hokanson JS, Poile C, Rosenthal M, Nakzawa M, Moller JH, Gillette PC, Webb GD, Redington AN (2000) Risk Factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. Lancet 356:975–981
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 11:61–68
Helbing WA, Rebergen SA, Malliepaard C, Hansen B, Ottenkamp J, Reiber JHC, de Roos A (1995) Quantification of right ventricular function with magnetic resonance imaging in children with normal hearts and with congenital heart disease. Am Heart J 130:828–837
Jamal F, Bergerot C, Argaud L, Loufouat J, Ovize M (2003) Longitudinal strain quantitates regional right ventricular contractile function. Am J Physiol Heart Circ Physiol 285:H2842–H2847
Koch A, Singer H (2003) Normal values of B type natriuretic peptide in in infants, children, and adolescents. Heart 89:875–878
Lange PE (1989) Long-term results following surgical treatment of tetralogy of Fallot. Z Kardiol 78 (Suppl 7):47–51
Langeland S, D’hooge J, Wouters PF, Leather A, Claus P, Bijnens B, Sutherland GR (2005) Experimental validation of a new ultrasound method for the simultaneous assessment of radial and longitudinal myocardial deformation independent of insonation angle. Circulation 112:2157–2162
Law YM, Keller BB, Feingold BM, Boyle GJ (2005) Usefulness of plasma B-type natriuretic peptide to identify ventricular dysfunction in pediatric and adult patients with congenital heart disease. Am J Cardiol 95:474–478
Leitman M, Lysayansky P, Sidenko S, Shir V, Peleq E, Binenbaum M, Kaluski E, Krakover R, Vered Z (2004) Two-dimensional strain—a novel software for real-time quantitative echocardiographic assessment of myocardial function. J Am Soc Echocardiogr 17:1021–1029
Levin ER, Gardner DG, Samson WK (1998) Natriuretic peptides. N Engl J Med 339:321–328
Lorenz CH (2000) The range of normal values of cardiovascular structures in infants, children, and adolescents measured by magnetic resonance imaging. Pediatr Cardiol 21:37–46
Niezen RA, Helbing WA, van der Wall EE, van der Geest RJ, Rebergen SA, Roos A (1996) Biventricular systolic function and mass studied with MR imaging in children with pulmonary regurgitation after repair for tetralogy of Fallot. Radiology 201:135–140
Nir A, Bar-Oz B, Perles Z, Brooks R, Korach A, Rein AJJT (2004) N-terminal pro-B-type natriuretic peptide: reference plasma levels from birth to adolescence: elevated levels at birth and in heart diseases. Acta Paediatr 93:603–607
Oechslin EN, Harrison DA, Harris L, Downar E, Webb GD, Siu SS, Williams WG (1999) Reoperation in adults with repair of Tetralogy of Fallot: indications and outcomes. J Thorac Cardiovasc Surg 118:245–251
Oosterhof T, Tulevski II, Vliegen HW, Spijkerboer AM, Mulder BJ (2006) Effects of volume and/or pressure overload secondary to congenital heart disease (tetralogy of Fallot or pulmonary stenosis) on right ventricular function using cardiac magnetic resonance and B-type natriuretic peptide levels. Am J Cardiol 97:1051–1055
Petersen SE, Jung BA, Wiesmann F, Selvanayagam JB, Francis JM, Hennig J, Neubauer S, Robson MD (2006) Myocardial tissue phase mapping with cine phase-contrast MR imaging: regional wall motion analysis in healthy volunteers. Radiology 238:816–826
Rodeheffer RJ (2004) Measuring plasma B-type natriuretic peptide in heart failure: good to go in 2004? J Am Coll Cardiol 44:740–749
Sanchez-Quintana D, Anderson RH, Ho SY (1996) Ventricular myoarchitecture in tetralogy of Fallot. Heart 76:280–286
Schamberger MS, Hurwitz RA (2000) Course of right and left ventricular function in patients with pulmonary insufficiency after repair of Tetralogy of Fallot. Pediatr Cardiol 21:244–248
Solarz DE, Witt SA, Glascock BJ, Jones FD, Khoury PR, Kimball TR (2004) Right ventricular strain and strain rate analysis in patients with repaired tetralogy of Fallot: possible interventricular septum compensation. J Am Soc Echocardiogr 17:338–344
Sutherland GR, Di Salvo G, Claus P, D’hooge J, Bijnens B (2004) Strain and strain rate imaging: a new clinical approach to quantifying regional myocardial function. J Am Soc Echocardiogr 17:788–802
Therrien J, Provost Y, Merchant N, Williams W, Colman J, Webb G (2005) Optimal timing for pulmonary valve replacement in adults after tetralogy of fallot repair. Am J Cardiol 95:779–782
Tulevski II, Hirsch A, Dodge-Khatami A, Stoker J, van der Wall EE, Mulder BJ (2003) Effect of pulmonary valve regurgitation on right ventricular function in patients with chronic right ventricular pressure overload. Am J Cardiol 92:113–116
Urheim S, Evardsen T, Torp H, Angelsen B, Smiseth OA (2000) Myocardial strain by doppler echocardiography—validation of a new method to quantify regional myocardial function. Circulation 102:1158–1164
Valsangiacomo Buechel ER, Dave HH, Kellenberger CJ, Dodge-Khatami A, Pretre R, Berger F, Bauersfeld U (2005) Remodelling of the right ventricle after early pulmonary valve replacement in children with repaired tetralogy of Fallot: assessment by cardiovascular magnetic resonance. Eur Heart J 26:2721–2727
Vliegen HW, van Straten A, de Roos A, Roest AA, Schoof PH, Zwindermann AH, Ottenkamp J, van der Wall EE, Hazekamp MG (2002) Magnetic resonance imaging to assess the hemondynamic effects of pulmonary valve replacement in adults repair of tetralogy of fallot. Circulation 106:1703–1707
Warner KG, O’Brian PKH, Rhodes J, Kaur A, Robinson DA, Payne DD (2003) Expanding the indications for pulmonary valve replacement after repair of Tetralogy of Fallot. Ann Thorac Surg 76:1066–1072
Weidemann F, Eyskens B, Mertens L, Dommke C, Kowalski M, Simmons L, Claus P, Binjes B, Gewellig M, Hatle L, Sutherland GR (2002) Quantification of regional right and left ventricular function by ultrasonic strain rate and strain indexes after surgical repair of tetralogy of Fallot. Am J Cardiol 90:133–138
Weidemann F, Jamal F, Sutherland GR, Claus P, Kowalski M, Hatle L, De Scheerder I, Bijnens B, Rademakers FE (2002) Myocardial function defined by strain rate and strain during alterations in inotropic states and heart rate. Am J Physiol Heart Circ Physiol 283:H792–H799
Wranne B, Pinto FJ, Hammarstrom E, St Goar FG, Puryear J, Popp RL (1991) Abnormal right heart filling after cardiac surgery: time course and mechanisms. Br Heart J 66:435–442
Young AA, Imai H, Chang CN, Axel L (1994) Two-dimensional left ventricular deformation during systole using magnetic resonance imaging with spatial modulation of magnetization. Circulation 89:740–752
Acknowledgments
This study was supported by a grant from the University of Zurich, Switzerland. We thank the parents and their children for their participation.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Knirsch, W., Dodge-Khatami, A., Kadner, A. et al. Assessment of Myocardial Function in Pediatric Patients with Operated Tetralogy of Fallot: Preliminary Results with 2D Strain Echocardiography. Pediatr Cardiol 29, 718–725 (2008). https://doi.org/10.1007/s00246-008-9227-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-008-9227-y