Journal of Cardiovascular Imaging

Korean Society of Echocardiography (한국심초음파학회)
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Right Ventricular Strain Is Associated With Increased Length of Stay After Tetralogy of Fallot Repair

  • Ranjini Srinivasan (Division of Pediatric Cardiology, Hassenfeld Children's Hospital, New York University Grossman School of Medicine) ;
  • Jennifer A. Faerber (Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, Children's Hospital of Philadelphia) ;
  • Grace DeCost (School of Public Health, Brown University) ;
  • Xuemei Zhang (Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, Children's Hospital of Philadelphia) ;
  • Michael DiLorenzo (Division of Cardiology, Morgan Stanley Children's Hospital of New York, Columbia University) ;
  • Elizabeth Goldmuntz (Division of Cardiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine) ;
  • Mark Fogel (Division of Cardiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine) ;
  • Laura Mercer-Rosa (Division of Cardiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine)
  • Received : 2021.04.21
  • Accepted : 2021.07.20
  • Published : 2022.01.27
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Abstract

BACKGROUND: Little is known regarding right ventricular (RV) remodeling immediately after Tetralogy of Fallot (TOF) repair. We sought to describe myocardial deformation by cardiac magnetic resonance imaging (CMR) after TOF repair and investigate associations between these parameters and early post-operative outcomes. METHODS: Fifteen infants underwent CMR without sedation as part of a prospective pilot study after undergoing complete TOF repair, prior to hospital discharge. RV deformation (strain) was measured using tissue tracking, in addition to RV ejection fraction (EF), volumes, and pulmonary regurgitant fraction. Pearson correlation coefficients were used to determine associations between both strain and CMR measures/clinical outcomes. RESULTS: Most patients were male (11/15, 73%), with median age at TOF repair 53 days (interquartile range, 13,131). Most patients had pulmonary stenosis (vs. atresia) (11/15, 73%) and 7 (47%) received a transannular patch as part of their repair. RV function was overall preserved with mean RV EF of 62% (standard deviation [SD], 9.8). Peak radial and longitudinal strain were overall diminished (mean ± SD, 33.80 ± 18.30% and -15.50 ± 6.40%, respectively). Longer hospital length of stay after TOF repair was associated with worse RV peak radial ventricular strain (correlation coefficient (r), -0.54; p = 0.04). Greater pulmonary regurgitant fraction was associated with shorter time to peak radial RV strain (r = -0.55, p = 0.03). CONCLUSIONS: In this small study, our findings suggest presence of early decrease in RV strain after TOF repair and its association with hospital stay when changes in EF and RV size are not yet apparent.

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References

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