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Echocardiographic parameters of severe pulmonary regurgitation after surgical repair of tetralogy of Fallot

An Van Berendoncks1,2, Roderick Van Grootel1, Jackie McGhie1, Matthijs van Kranenburg1, Myrthe Menting1, Judith A.A.E. Cuypers1, Ad J.J.C. Bogers3, Maarten Witsenburg1, Jolien W. Roos‐Hesselink1, Annemien E. van den Bosch1
1 Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
2 Department of Cardiology, Antwerp University Hospital, Antwerp Belgium
3 Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
* Corresponding Author: Jolien W. Roos‐Hesselink, Department of Cardiology, Erasmus Medical Center, Congenital heart disease RG4, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. Email:

Congenital Heart Disease 2019, 14(4), 628-637. https://doi.org/10.1111/chd.12762

Abstract

Aims: Reliable evaluation of the severity and consequences of pulmonary regurgita‐ tion (PR) in patients with repaired tetralogy of Fallot (TOF) is crucial to timely identify the need for pulmonary valve intervention. We aimed to identify the accuracy of echocardiographic parameters to differentiate between moderate and severe PR, using phase contrast cardiac magnetic resonance imaging (CMR) as gold standard.
Methods and results: In this cross‐sectional study, 45 TOF patients with both echo‐ cardiographic and CMR measurements of PR were enrolled. All quantitative and semiquantitative echocardiographic measurements such as pressure half time (PHT), Color flow jet width (CFJW), ratio CFJW/right ventricle outflow tract (RVOT) diame‐ ter, PR index and the presence of early termination of the PR jet, end‐diastolic ante‐ grade flow and diastolic backflow in main pulmonary artery (MPA), and PA branches correlated significantly with PR fraction on CMR. Qualitative assessment with color flow on echocardiography overestimated PR Multivariate linear regression analysis identified the ratio of CFJW/RVOT diameter and PHT as independent predictors of PR fraction. Accuracy of echo parameters was tested to differentiate between mild‐ to‐moderate and severe PR Combining different echocardiographic parameters in‐ creased sensitivity and specificity. The addition of diastolic flow reversal in the PA branches to PHT below 167 milliseconds increased the NPV from 87% to 89% and PPV from 62% to 76%.
Conclusions: Comparison with CMR confirms that echocardiographic parameters are reliable in predicting PR severity. Combined measurement of diastolic flow reversal in the pulmonary artery branches and PHT is reliable in the detection of severe PR in the follow‐up of TOF patients.

Keywords

CMR, echocardiography, pulmonary regurgitation, TOF

Cite This Article

Berendoncks, A. V., Grootel, R. V., McGhie, J., Kranenburg, M. V., Menting, M. et al. (2019). Echocardiographic parameters of severe pulmonary regurgitation after surgical repair of tetralogy of Fallot. Congenital Heart Disease, 14(4), 628–637.



This work is licensed under a Creative Commons Attribution 4.0 International License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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