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Impact of pressure load caused by right ventricular outflow tract obstruction on right ventricular volume overload in patients with repaired tetralogy of Fallot

Authors
 Byung Won Yoo  ;  Jung Ok Kim  ;  Young Jin Kim  ;  Jae Young Choi  ;  Han Ki Park  ;  Young Hwan Park  ;  Jun Hee Sul 
Citation
 JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, Vol.143(6) : 1299-1304, 2012 
Journal Title
 JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 
ISSN
 0022-5223 
Issue Date
2012
MeSH
Adolescent ; Adult ; Cardiac Surgical Procedures*/adverse effects ; Chi-Square Distribution ; Child ; Echocardiography ; Female ; Humans ; Hypertrophy, Right Ventricular/etiology ; Hypertrophy, Right Ventricular/physiopathology ; Hypertrophy, Right Ventricular/prevention & control ; Linear Models ; Magnetic Resonance Imaging ; Male ; Multivariate Analysis ; Pulmonary Valve Insufficiency/etiology ; Pulmonary Valve Insufficiency/physiopathology ; Pulmonary Valve Insufficiency/surgery ; Pulmonary Valve Stenosis/complications ; Pulmonary Valve Stenosis/physiopathology ; Pulmonary Valve Stenosis/surgery ; Republic of Korea ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Stroke Volume ; Tetralogy of Fallot/complications ; Tetralogy of Fallot/diagnosis ; Tetralogy of Fallot/physiopathology ; Tetralogy of Fallot/surgery* ; Treatment Outcome ; Ventricular Dysfunction, Right/diagnosis ; Ventricular Dysfunction, Right/etiology ; Ventricular Dysfunction, Right/physiopathology ; Ventricular Dysfunction, Right/prevention & control* ; Ventricular Function, Right* ; Ventricular Outflow Obstruction/diagnosis ; Ventricular Outflow Obstruction/etiology ; Ventricular Outflow Obstruction/physiopathology ; Ventricular Outflow Obstruction/prevention & control* ; Ventricular Pressure* ; Young Adult
Keywords
Adolescent ; Adult ; Cardiac Surgical Procedures*/adverse effects ; Chi-Square Distribution ; Child ; Echocardiography ; Female ; Humans ; Hypertrophy, Right Ventricular/etiology ; Hypertrophy, Right Ventricular/physiopathology ; Hypertrophy, Right Ventricular/prevention & control ; Linear Models ; Magnetic Resonance Imaging ; Male ; Multivariate Analysis ; Pulmonary Valve Insufficiency/etiology ; Pulmonary Valve Insufficiency/physiopathology ; Pulmonary Valve Insufficiency/surgery ; Pulmonary Valve Stenosis/complications ; Pulmonary Valve Stenosis/physiopathology ; Pulmonary Valve Stenosis/surgery ; Republic of Korea ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Stroke Volume ; Tetralogy of Fallot/complications ; Tetralogy of Fallot/diagnosis ; Tetralogy of Fallot/physiopathology ; Tetralogy of Fallot/surgery* ; Treatment Outcome ; Ventricular Dysfunction, Right/diagnosis ; Ventricular Dysfunction, Right/etiology ; Ventricular Dysfunction, Right/physiopathology ; Ventricular Dysfunction, Right/prevention & control* ; Ventricular Function, Right* ; Ventricular Outflow Obstruction/diagnosis ; Ventricular Outflow Obstruction/etiology ; Ventricular Outflow Obstruction/physiopathology ; Ventricular Outflow Obstruction/prevention & control* ; Ventricular Pressure* ; Young Adult
Abstract
OBJECTIVES: In correction of tetralogy of Fallot (TOF), surgical strategies to minimize right ventricular outflow tract (RVOT) enlargement have recently been preferred. However, we may be confronted with residual pulmonary stenosis (PS) combined with pulmonary regurgitation (PR), and how the pressure load affects these patients is not evident. METHODS: We compared 51 patients with PR and significant PS (PR with PS group) with 87 patients with PR without significant PS (PR group) using echocardiography and cardiac magnetic imaging. We evaluated the differences in parameters derived by magnetic resonance imaging between the 2 groups and the influence of the pressure load on right ventricular (RV) volume and function. RESULTS: Although the PR fraction was similar between the 2 groups, the PR with PS group showed significantly smaller RV end-diastolic volume (136.7 ± 26.5 mL/m(2) vs 151.2 ± 34.7 mL/m(2); P = .01), RV end-systolic volume (68.1 ± 23.7 mL/m(2) vs 80.2 ± 27.5 mL/m(2); P = .01), and slightly better RV ejection fraction (51.1% ± 9.8% vs 47.6% ± 8.9%; P = .03) than the PR group. For influence of the pressure load, PR fraction (r = -0.18, P = .03), RV end-diastolic volume (r = -0.25, P = .003), and RV end-systolic volume (r = -0.24, P = .005) were decreased as peak pressure gradient of PS was higher. Linear regression analysis revealed that both PR fraction and peak pressure gradient of PS were independent predictors for RV volume. CONCLUSIONS: Our study demonstrated that the RV pressure load prevented RV dilatation from chronic PR without systolic dysfunction. It is suggested that a proper relief of RVOT obstruction with acceptable residual stenosis is more advantageous than aggressive RVOT enlargement in the long-term outcome of repaired TOF.
Full Text
http://www.sciencedirect.com/science/article/pii/S0022522311014516
DOI
22244553
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pediatrics (소아청소년과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Young Jin(김영진) ORCID logo https://orcid.org/0000-0002-6235-6550
Kim, Jung Ok(김정옥)
Yoo, Byung Won(류병원) ORCID logo https://orcid.org/0000-0001-6895-1484
Park, Young Hwan(박영환)
Park, Han Ki(박한기) ORCID logo https://orcid.org/0000-0002-7472-7822
Sul, Jun Hui(설준희)
Choi, Jae Young(최재영) ORCID logo https://orcid.org/0000-0002-1247-6669
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/91171
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