Pulmonary valve replacement (PVR) reduces right ventricular (RV) volumes in the setting of pulmonary regurgitation long term after Tetralogy of Fallot (ToF) repair but little is known of its effect on RV diastolic function. Right atrial volumes and pulmonary end-diastolic forward flow (EDFF) may reflect the burden of RV diastolic dysfunction. We evaluate right ventricular diastolic function prior to and after elective PVR in adult patients with ToF using cardiac magnetic resonance imaging to determine EDFF and right atrial volumes.

Prospective study conducted from January 2009 to April 2013 in twenty consecutive patients >18 years of age who had undergone ToF repair in childhood and accepted for elective PVR. Cardiac magnetic resonance imaging was performed in all patients prior to and 12 months after PVR For pulmonary regurgitation evaluation, through-plane velocity imaging perpendicular to the main pulmonary artery was performed using a breath-holding, electrocardiogram-triggered, cine-phase contrast pulse sequence. Forward and regurgitant pulmonary flow volume was measured from the velocity-encoded images by manually tracing the main...

EDFF decreased significantly from 5.4 ml/m2 to 0.3 ml/m2 (p<0.00001) Prior to surgery, mean indexed diastolic atrial volume was 43 ml/m2(SD +/-4.6), and mean indexed systolic atrial volume 63ml/m2 (SD +/-5.5), whereas post-surgery, mean indexed diastolic atrial volume was 33ml/m2(SD+/-3), and mean indexed systolic atrial volume 46ml/2(SD +/- 2.55),p=0.0024.All patients presented a right ventricular diastolic and systolic volume reduction, with a mean volume reduction of 35% (p<00001) Atrial function, defined as ejection fraction, showed no statistically-significant change: mean 34% prior to surgery (SD +/- 2.3)...

Right ventricular diastolic dysfunction was common in a population of severely dilated RV patients long term after ToF repair. Right ventricular diastolic parameters improved as did right atrial volumes in keeping with the known reduction in RV volumes, after PVR.

1. Geva T. Indications for Pulmonary Valve Replacement in Repaired Tetralogy of Fallot:The Quest Continues. Circulation. 2013;128(17):1855-7. 2. Helbing W, Niezen A, LE CEssie S, Van der Geest R, Ottenkamp J. de Roos A. Right Ventricular diastolic function in children with pulmonary regurgitation After Repair of Tetralogy of Fallot: volumetric evaluation by magnetic resonance velocity mapping. J Am Coll Cardiol 1996;28:1827–3. 3. Lee W, Yoo SJ, Roche S, Kantor P, van Arsdell G, Park E,Redington A, Grosse-Wortmann L.Determinants and functional impact of restrictive physiology after...