Hostname: page-component-7479d7b7d-k7p5g Total loading time: 0 Render date: 2024-07-14T05:49:46.788Z Has data issue: false hasContentIssue false

Early postoperative remodelling following repair of tetralogy of Fallot utilising unsedated cardiac magnetic resonance: a pilot study

Published online by Cambridge University Press:  15 February 2018

Michael P. DiLorenzo*
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, New York-Presbyterian/Morgan Stanley Children’s Hospital, Columbia University Medical Center, New York, NY, USA Department of Pediatrics, Division of Pediatric Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Elizabeth Goldmuntz
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Susan C. Nicolson
Affiliation:
Department of Anesthesia, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Mark A. Fogel
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Laura Mercer-Rosa
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
*
Author for correspondence: M. P. DiLorenzo, MD, MSCE, New York-Presbyterian/Morgan Stanley Children’s Hospital, 3959 Broadway, 2 North, New York, NY 10032, USA. Tel: 212 304 7492; Fax: 212 342 5704; E-mail: mpd2001@columbia.edu

Abstract

Introduction

The right ventricular adaptations early after surgery in infants with tetralogy of Fallot are important to understand the changes that occur later on in life; this physiology has not been fully delineated. We sought to assess early postoperative right ventricular remodelling in patients with tetralogy of Fallot by cardiac MRI.

Materials and method

Subjects with tetralogy of Fallot under 1 year of age were recruited following complete surgical repair for tetralogy of Fallot. Protocol-based cardiac MRI to assess anatomy, function, and flows was performed before hospital discharge using the feed and sleep technique, an unsedated imaging technique.

Results

MRI was completed in 16 subjects at a median age of 77 days (interquartile range 114). There was normal ventricular ejection fraction and indexed right ventricular end-diastolic volume (48±13 cc/m2), but elevated right ventricular mass (z score 6.2±2.4). Subjects requiring a transannular patch or right ventricle to pulmonary artery conduit had moderate pulmonary insufficiency (regurgitant fraction 27±16%).

Discussion

Early right ventricular remodelling after surgical repair for tetralogy of Fallot is characterised by significant pulmonary regurgitation, right ventricular hypertrophy, and lack of dilation. Performing cardiac MRI using the feed and sleep technique is feasible in infants younger than 5 months. These results might open new avenues to study longitudinal right ventricular changes in tetralogy of Fallot and to further explore the utility of unsedated MRI in patients with other types of CHDs.

Type
Original Articles
Copyright
© Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Murphy, JG, Gersh, BJ, Mair, DD, et al. Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot. N Engl J Med 1993; 329: 593599.CrossRefGoogle ScholarPubMed
2. Nollert, G, Fischlein, T, Bouterwek, S, Böhmer, C, Klinner, W, Reichart, B. Long-term survival in patients with repair of tetralogy of Fallot: 36-year follow-up of 490 survivors of the first year after surgical repair. J Am Coll Cardiol 1997; 30: 13741383.CrossRefGoogle ScholarPubMed
3. Bouzas, B, Kilner, PJ, Gatzoulis, MA. Pulmonary regurgitation: not a benign lesion. Eur Heart J 2005; 26: 433439.CrossRefGoogle Scholar
4. Gatzoulis, MA, Balaji, S, Webber, SA, et al. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. Lancet 2000; 356: 975981.CrossRefGoogle ScholarPubMed
5. Geva, T, Sandweiss, BM, Gauvreau, K, Lock, JE, Powell, AJ. Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging. J Am Coll Cardiol 2004; 43: 10681074.CrossRefGoogle ScholarPubMed
6. Kilner, PJ, Geva, T, Kaemmerer, H, Trindade, PT, Schwitter, J, Webb, GD. Recommendations for cardiovascular magnetic resonance in adults with congenital heart disease from the respective working groups of the European Society of Cardiology. Eur Heart J 2010; 31: 794805.CrossRefGoogle ScholarPubMed
7. Knauth, AL, Gauvreau, K, Powell, AJ, et al. Ventricular size and function assessed by cardiac MRI predict major adverse clinical outcomes late after tetralogy of Fallot repair. Heart 2008; 94: 211216.CrossRefGoogle ScholarPubMed
8. Niezen, RA, Helbing, WA, Van der Wall, EE, Van der Geest, RJ, Rebergen, SA, De Roos, A. Biventricular systolic function and mass studied with MR imaging in children with pulmonary regurgitation after repair for tetralogy of Fallot. Radiology 1996; 201: 135140.CrossRefGoogle ScholarPubMed
9. Villafañe, J, Feinstein, JA, Jenkins, KJ, et al. Hot topics in tetralogy of Fallot. J Am Coll Cardiol 2013; 62: 21552166.CrossRefGoogle ScholarPubMed
10. Rebergen, SA, Chin, JG, Ottenkamp, J, Van der Wall, EE, De Roos, A. Pulmonary regurgitation in the late postoperative follow-up of tetralogy of Fallot. Volumetric quantitation by nuclear magnetic resonance velocity mapping. Circulation 1993; 88: 22572266.CrossRefGoogle ScholarPubMed
11. Pigula, FA, Khalil, PN, Mayer, JE, Pedro, J, Jonas, RA. Repair of tetralogy of Fallot in neonates and young infants. Circulation 1999; 100: II157II161.CrossRefGoogle ScholarPubMed
12. Sachdev, MS, Bhagyavathy, A, Varghese, R, Coelho, R, Kumar, RS. Right ventricular diastolic function after repair of tetralogy of Fallot. Pediatr Cardiol 2006; 27: 250255.CrossRefGoogle ScholarPubMed
13. Mercer-Rosa, L, Pinto, N, Yang, W, Tanel, R, Goldmuntz, E. 22q11.2 deletion syndrome is associated with perioperative outcome in tetralogy of Fallot. J Thorac Cardiovasc Surg 2013; 146: 868873.CrossRefGoogle ScholarPubMed
14. Fogel, MA, Pawlowski, TW, Harris, MA, et al. Comparison and usefulness of cardiac magnetic resonance versus computed tomography in infants six months of age or younger with aortic arch anomalies without deep sedation or anesthesia. Am J Cardiol 2011; 108: 120125.CrossRefGoogle ScholarPubMed
15. Shariat, M, Mertens, L, Seed, M, et al. Utility of feed-and-sleep cardiovascular magnetic resonance in young infants with complex cardiovascular disease. Pediatr Cardiol 2015; 36: 809812.CrossRefGoogle ScholarPubMed
16. Windram, J, Grosse-Wortmann, L, Shariat, M, Greer, M-L, Crawford, MW, Yoo, S-J. Cardiovascular MRI without sedation or general anesthesia using a feed-and-sleep technique in neonates and infants. Pediatr Radiol 2012; 42: 183187.CrossRefGoogle ScholarPubMed
17. Buechel, E, Kaiser, T, Jackson, C, Schmitz, A, Kellenberger, CJ. Normal right- and left ventricular volumes and myocardial mass in children measured by steady state free precession cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2009; 11: 19.CrossRefGoogle ScholarPubMed
18. Sluysmans, T. Theoretical and empirical derivation of cardiovascular allometric relationships in children. J Appl Physiol 2005; 99: 445457.CrossRefGoogle ScholarPubMed
19. Lee, C, Lee, C-H, Kwak, JG, et al. Factors associated with right ventricular dilatation and dysfunction in patients with chronic pulmonary regurgitation after repair of tetralogy of Fallot: analysis of magnetic resonance imaging data from 218 patients. J Thorac Cardiovasc Surg 2014; 148: 25892595.CrossRefGoogle ScholarPubMed
20. Mercer-Rosa, L, Paridon, SM, Fogel, MA, et al. 22q11.2 deletion status and disease burden in children and adolescents with tetralogy of Fallot. Circ Cardiovasc Genet 2015; 8: 7481.CrossRefGoogle ScholarPubMed
21. Chaturvedi, RR, Redington, AN. Pulmonary regurgitation in congenital heart disease. Heart 2007; 93: 880889.CrossRefGoogle ScholarPubMed
22. Redington, AN. Determinants and assessment of pulmonary regurgitation in tetralogy of Fallot: practice and pitfalls. Cardiol Clin 2006; 24: 631639.CrossRefGoogle ScholarPubMed
23. Harris, MA, Whitehead, KK, Gillespie, MJ, et al. Differential branch pulmonary artery regurgitant fraction is a function of differential pulmonary arterial anatomy and pulmonary vascular resistance. JACC Cardiovasc Imaging 2011; 4: 506513.CrossRefGoogle ScholarPubMed
24. Rangamani, S, Varghese, J, Li, L, et al. Safety of cardiac magnetic resonance and contrast angiography for neonates and small infants: a 10-year single-institution experience. Pediatr Radiol 2012; 42: 13391346.CrossRefGoogle ScholarPubMed
25. Dorfman, A, Odegard, K, Powell, A, Laussen, P, Geva, T. Risk factors for adverse events during cardiovascular magnetic resonance in congenital heart disease. J Cardiovasc Magn Reson 2007; 9: 793798.CrossRefGoogle ScholarPubMed