@Article{chd.12762,
AUTHOR = {An Van Berendoncks, Roderick Van Grootel, Jackie McGhie, Matthijs van Kranenburg, Myrthe Menting, Judith A.A.E. Cuypers, Ad J.J.C. Bogers, Maarten Witsenburg, Jolien W. Roos‐Hesselink, Annemien E. van den Bosch},
TITLE = {Echocardiographic parameters of severe pulmonary regurgitation after surgical repair of tetralogy of Fallot},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {14},
YEAR = {2019},
NUMBER = {4},
PAGES = {628--637},
URL = {http://www.techscience.com/schd/v14n4/39281},
ISSN = {3071-1738},
ABSTRACT = {<b>Aims:</b> 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.<br/>
<b>Methods and results:</b> 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%.<br/>
<b>Conclusions:</b> 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.},
DOI = {10.1111/chd.12762}
}