Skip to main content Accessibility help

Echocardiographic assessment of left ventricular function at rest and during exercise in postoperative patients with tetralogy of Fallot

  • Gunnar Norgård (a1), Kai Andersen (a1) and Harald Vik-Mo (a1)


Digitized M-mode echocardiograms of left ventricular function were obtained in 34 patients subsequent to surgical repair of tetralogy of Fallot and in 34 healthy subjects at rest. In 16 patients and 16 controls, studies were also made during submaximal semisupine bicycle exercise. At rest, the peak ejection rate and fractional shortening were slightly reduced in the patients, whereas peak filling rate was comparable in patients and controls. Pulmonary regurgitation did not seem to influence left ventricular function. During exercise, however, peak filling rate was reduced in the patients compared to the healthy subjects. At peak exercise, the peak filling rates were 27.8±6.3 cm•s−1 and 34.1±3.4 cm•s−1 in patients and controls, respectively (p<0.01). No differences were found in heart rate, fractional shortening, peak ejection rate or blood pressures between patients and controls throughout the exercise test. When the subjects were subdivided by median age, the oldest patients had reduced normalized peak filling rates throughout the exercise test, whereas no differences were found between younger and older healthy subjects. Thus, it is suggested that the reduced left ventricular peak filling rate found during exercise is caused by subclinical myocardial dysfunction which seems to be related to myocardial protection at surgery and the period of follow-up.


Corresponding author

Dr. Gunnar Norgård, Department of Clinical Physiology, 5021 Haukeland Hospital, Bergen. Norway. Tel. (05) 972200.


Hide All
Graham, TP Jr. Assessing the results of surgery for congenital heart disease: A continuing process. Circulation 1978; 65: 10491051.
Rocchini, AP, Keane, JF, Freed, MD, Castafieda, AR, Nadas, AS.Left ventricular function following attempted surgical repair of tetralogy of Fallot. Circulation 1978; 57: 798802.
Colan, SD, Borow, KM, Neumann, A.Left ventricular end-systolic wall stress-velocity offiber shortening relation: A load-independent index of myocardial contractility. J Am Coll Cardiol 1984; 4:715724.
Borow, KM, Green, LH, Castanñeda, AR, Keane, JF.Left ventricular function after repair of tetralogy of Fallot and its relationship to age at surgery. Circulation 1980; 61: 11511158.
Franklin, RCG, Wyse, RHK, Graham, TP, Gooch, VM, Deanfleld, JE.Normal values for noninvasive estimation of left ventricular contractile state and afterload in children. Am J Cardiol 1990; 65: 505510.
Sandor, GGS, Patterson, MWH, Tipple, M, Ashmore, PG, Popov, R.Left ventricular systolic and diastolic function after total correction of tetralogy of Fallot. Am J Cardiol 1987; 60: 11481151.
Davies, SW, Fussel, AL, Jordan, SL, Poole-Wilson, PA, Lipkin, DP.Abnormal diastolic filling patterns in chronic heart failure—relationship to exercise capacity. Eur Heart J 1992; 13: 749757.
Gibson, DG, Brown, DJ.Measurement of peak rates of left ventricular wall movement in man. Comparison of echocardiography with angiography. Br Heart J 1975; 37: 677683.
Danielsen, R, Nordrehaug, JE, Vik-Mo, H.Left ventricular diastolic function in young long-term type I (insulin-dependent) diabetic men during exercise assessed by digitized echocardiography. Eur Heart J 1988; 9: 395402.
Danielsen, R, Nordrehaug, JE, Vik-Mo, H.Left ventricular performance during exercise in long-term type I diabetic men: An echocardiographic study. Clin Physiol 1988; 8: 475486.
Norgård, G, Johannessen, KA.Variability of digitized M-mode echocardiography: A study in healthy subjects and patients with repaired tetralogy of Fallot. Clin Physiol 1993; 13: 373383.
Sahn, DJ, DeMaria, A, Kisslo, J, Weyman, A.The committee on M-mode standardization of the American Society of Echocar diography: recommendation regarding quantitation in M-mode echocardiography; results ofa survey of echocardiographic measurements. Circulation 1978; 58: 10721078.
Herve, CH, Duval, AM, Malak, J, Meguira, A, Brun, P.Relations between posterior wall kinetics during diastole and left ven tricular filling. J Am Coll Cardiol 1990; 15: 15871593.
Miyake, T, Yokoyama, T, Sunakawa, A, Shinohara, T, Nakamura, Y.Quantitative assessment of pulmonary regurgitation by two-dimensional Doppler color flow imaging: Postoperative evaluation of patients with tetralogy of Fallot. J Cardiol 1989; 19: 901910.
Norgård, G, Bjorkhaug, A, Vik-Mo, H.Effects ofimpaired lung function and pulmonary regurgitation on maximal exercise capacity in patients with repaired tetralogyof Fallot. Eur Heart J 1992; 13; 13801386.
James, FW, Blomquist, CG, Freed, MD, Miller, WW, Moller, JH, Nugent, EW, Riopel, DA, Strong, WB, Wessel, HU.Standards for exercise testing in the pediatric age group. American Heart Association Council on Cardiovascular Disease in the Young. Circulation 1982; 66: 1377A1397A.
Braunwald, E, SonnenblickEH, EH,Ross, J. Mechanisms ofcardiac contraction and relaxation. In: Braunwald, E (ed). Heart Disease: A Textbook of Cardiovascular Medicine. W.B. Saunders, Philadelphia, 1992, pp 351392.
Altman, DG. Relation between several variables. In: Altman, DG (ed). Practical Statistics for Medical Research. Chapman and Hall, London, 1991, pp 325336.
Andersen, K, Vik-Mo, H.Increased left ventricular emptying at maximal exercise after reduction in afterload. Circulation 1984; 69: 492496.
Pierard, LA, Serruys, PW, Roelandt, J, Meltzer, RS.Left ven tricular function at similar heart rates during tachycardia induced by exercise and atrial pacing: an echocardiographic study. Br Heart J 1987; 57: 154160.
DeMaria, AN, Neumann, A, Schubart, PJ, Lee, G, Mason, DT.Systematic correlation of cardiac chamber size and ventricular performance determinedwith echocardiographyand alterations in heart rate in normal persons. Am J Cardiol 1979; 43: 19.
De Lorgeril, M, Friedli, B, Assimacopoulos A. Factors affecting left ventricular function after correction of tetralogy of Fallot. Br Heart J 1984; 52: 536541.
Bahler, RC, Vrobel, TR, Martin, P.The relation of heart rate and shortening fraction to echocardiographic indexes of left ventricular relaxation in normal subjects. J Am Coll Cardiol 1983; 2: 926933.
Danielsen, R, Nordrehaug, JE, Vik-Mo, H.Importance of adjusting left ventricular diastolic peak filling rate for heart rate. Am J Cardiol 1988; 61: 489491.
Shapiro, E, Marier, DL, John Sutton, MGST, Gibson, DG.Regional non-uniformity of wall dynamics in normal left ventricle. Br Heart J 1981; 45: 264270.
Marx, GR, Hicks, RW, Allen, HD, and Goldberg, S.Noninvasive assessment of hemodynamic responses to exercise in pulmonary regurgitation after operations to correct pulmonary outflow obstructions. Am J Cardiot 1988; 61: 596601.


Echocardiographic assessment of left ventricular function at rest and during exercise in postoperative patients with tetralogy of Fallot

  • Gunnar Norgård (a1), Kai Andersen (a1) and Harald Vik-Mo (a1)


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed