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Improved right ventricular outflow tract function in patients with Tetralogy of Fallot after infundibular sparing compared to transventricular repair
© Maskatia et al; licensee BioMed Central Ltd. 2015
- Published: 3 February 2015
- Cardiac Magnetic Resonance
- Pulmonary Valve
- Tract Volume
- Septal Band
- RVOT Obstruction
The right ventricular infundibular sparing approach (RVIS) to repair tetralogy of Fallot (TOF) avoids a ventricular incision used in the transventricular (TV) approach. Recent data has demonstrated better global right ventricular systolic function in patients who underwent RVIS compared to those who had a TV repair, however the impact of surgical strategy on RV infundibular size and function is not specifically known. We hypothesized that patients repaired with the RVIS approach have improved RV outflow tract ejection fraction (RVOTEF) and have lower RV outflow tract volumes as assessed by cardiac magnetic resonance (CMR) compared with those repaired with the TV approach.
Sixty patients were included in the analysis; 30 underwent RVIS repair at median age of 10.8 months (IQR: 6.3-29.3) and 30 underwent TV repair at median age of 4.2 months (IQR: 2.2-7.0), (p<0.01). No patient in the TV group had an initial palliation with a systemic to pulmonary arterial shunt compared to 4 (13%) in the RVIS group (p<0.01). The median age at CMR was 8.4 years (IQR: 5.6-13.8) in the RVIS group and 7.9 years (IQR: 3.4-12.0) in the TV group (p=0.40). Compared to the TV group, the RVIS group had higher RVOTEF (51± 8% vs 42 ± 12%, p<0.01), lower RVOTEDV (25 ± 8 cc/m2 vs 32 ± 12 cc/m2, p=0.02), and lower RVOTESV (12 ± 4 cc/m2 vs 18 ± 8 cc/m2, p<0.01). There was a modest correlation between RVOTEF and global RVEF (R=0.42, p<0.01).
Patients who underwent RVIS repair for TOF appeared to have less dilation and improved systolic function of the RVOT compared to a matched cohort repaired using the TV approach. Favorable alteration in infundibular characteristics may explain the improved RV systolic function seen with the RVIS approach. Further work is needed to determine whether these differences are predictive of clinical outcomes.
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