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. 2019 Jan 17;8(2):e010903. doi: 10.1161/JAHA.118.010903

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© 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

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Valvular regurgitation (top) and global right ventricular (RV) contractility (bottom) as functions of exercise level in virtual patients with tetralogy of Fallot repair (rTOF) and normal (A) and decreased (B) contractile function of the RV and right atrial (RA) myocardium. The 4 representative virtual patients with rTOF are the same as in Figures 4 and 5. Lines are plotted until maximal cardiac output during exercise (CO _max‐exc) is reached. The pathological consequences of pulmonary regurgitation (PR), as quantified by PR fraction, decrease with exercise level (top), whereas RV dyssynchrony reduces RV global contractility and this effect becomes more pronounced as exercise level increases. dp/dt_max indiicates maximal change in pressure over time.