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. 1999 Dec;82(6):697–703. doi: 10.1136/hrt.82.6.697

Left ventricular function in adults with mild pulmonary insufficiency late after Fallot repair

R Niezen 1, W Helbing 1, E E van der Wall 1, R J van der Geest 1, H Vliegen 1, A de Roos 1
PMCID: PMC1729208  PMID: 10573497

Abstract

OBJECTIVE—To assess left ventricular function in adult Fallot patients with residual pulmonary regurgitation.
SETTING—The radiology department of a tertiary referral centre.
PATIENTS—14 patients with chronic pulmonary regurgitation and right ventricular volume overload after repair of tetralogy of Fallot and 10 healthy subjects were studied using magnetic resonance imaging.
MAIN OUTCOME MEASURES—Biventricular volumes, global biventricular function, and regional left ventricular function were assessed in all subjects.
RESULTS—The amount of pulmonary regurgitation in patients (mean (SD)) was 25 (18)% of forward flow and correlated significantly with right ventricular enlargement (p < 0.05). Left ventricular end diastolic volume was decreased in patients (78 (11) v 88 (10) ml/m2; p < 0.05), ejection fraction was not significantly altered (59 (5)% v 55 (7)%; NS). No significant correlation was found between pulmonary regurgitation and left ventricular function. Overall left ventricular end diastolic wall thickness was significantly lower in patients (5.06 (0.72) v 6.06 (1.06) mm; p < 0.05), predominantly in the free wall. At the apical level, left ventricular systolic wall thickening was 20% higher in Fallot patients (p < 0.05). Left ventricular shape was normal.
CONCLUSIONS—Adult Fallot patients with mild chronic pulmonary regurgitation and subsequent right ventricular enlargement showed a normal left ventricular shape and global function. Although the left ventricular free wall had reduced wall thickness, compensatory hypercontractility of the apex may contribute to preserved global function.


Keywords: left ventricular function; pulmonary insufficiency; tetralogy of Fallot; magnetic resonance imaging

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Figure 1  .

Figure 1  

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Schematic representation of the method used to correct for through plane motion of the ventricle. A standardised subdivision in six levels from apex to base was established, levels 1 and 6 corresponding to the most apical and basal image slice, respectively, and the other levels at evenly spaced intervals computed by linear interpolation of the corresponding two neighbouring image slices. Levels 1 and 2 were defined as apical, levels 3 and 4 as midventricular, and levels 5 and 6 as basal. ED, end diastole; ES, end systole.

Figure 2  .

Figure 2  

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Example of an end diastolic midventricular short axis slice through the heart of a healthy volunteer. The centreline cords subdivide the left ventricular wall in a clockwise fashion into eight regions starting at the junction of both ventricles.

Figure 3  .

Figure 3  

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Regression analysis of pulmonary regurgitation (PR) with right ventricular end diastolic volume (RV-ED) (A), end systolic volume (RV-ES) (B), and stroke volume (RV-SV) (C) in postoperative Fallot patients.       

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