@Article{chd.12772,
AUTHOR = {Vidhya Annavajjhala, Rajesh Punn, Theresa A. Tacy, Frank L. Hanley, Doff B. McElhinney},
TITLE = {Serial assessment of postoperative ventricular mechanics in young children with tetralogy of Fallot: Comparison of transannular patch and valve‐sparing repair},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {14},
YEAR = {2019},
NUMBER = {5},
PAGES = {691--699},
URL = {http://www.techscience.com/schd/v14n5/38835},
ISSN = {3071-1738},
ABSTRACT = {<b>Background:</b> Little is known about the early time course of biventricular function and
mechanics after tetralogy of Fallot (TOF) repair. We sought to evaluate and describe
the evolution of the right ventricle (RV) after TOF repair in young infants and children
using conventional echocardiographic parameters and global longitudinal strain
(GLS).<br/>
<b>Methods:</b> A retrospective review was performed of all patients with TOF and pulmo‐
nary stenosis who underwent repair from January 2002 to September 2015 and had
at least 3 serial postsurgical echocardiograms spanning from infancy to early child‐
hood (<8 years). Student’s t test was performed to compare patients who underwent
valve sparing (VS) versus transannular patch (TAP) repair. ANOVA was used to track
measures of ventricular systolic function over time.<br/>
<b>Results: </b>We analyzed 151 echocardiograms performed on 42 patients. Pulmonary
regurgitation (PR, moderate or severe) and the RV to left ventricular (LV) basal dimen‐
sion ratio were higher in TAP patients (P < .04 at all‐time points). Along with a signifi‐
cant increase in RV basal diameter Z‐score in the TAP group (P < .001), there was an
improvement in RV and LV GLS over time in both groups (P < .001). The LV GLS at last
follow‐up was lower in patients who underwent reoperation than those who did not
(P = .050). LV GLS at the last follow‐up echocardiogram was lower in patients with
significant PR than those without (P < .001).<br/>
<b>Conclusions: </b>Ventricular function appeared improve over time from the initial post‐
operative period in TOF patients. TAP repair was associated with a progressively
higher RV/LV ratio in young children. GLS and RV/LV basal diameter ratio may be
useful when following young children after TOF repair. Further research is necessary
to understand the trajectory of ventricular functional and volumetric changes in
young children in order to provide the most effective lifetime management of pa‐
tients with TOF.},
DOI = {10.1111/chd.12772}
}