European Heart Journal Advance Access originally published online on January 22, 2009
European Heart Journal 2009 30(3):356-361; doi:10.1093/eurheartj/ehn595
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Refining the assessment of pulmonary regurgitation in adults after tetralogy of Fallot repair: should we be measuring regurgitant fraction or regurgitant volume?
1 Department of Cardiology, Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, North Wing, 5N-517, 585 University Avenue, Toronto, Ontario, Canada M5G 2C4
2 Department of Medical Imaging, Toronto Congenital Cardiac Centre for Adults, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
Received 26 February 2008; revised 6 November 2008; accepted 17 December 2008; online publish-ahead-of-print 22 January 2009.
* Corresponding author. Tel: +1 416 340 5502, Fax: +1 416 340 5014, Email: rachel.wald{at}uhn.on.ca
Aims: Pulmonary regurgitation (PR) is an important determinant of outcome after tetralogy of Fallot (TOF) repair. The physiologic impact of PR on the right ventricle remains incompletely understood. We hypothesized that a volumetric expression of PR would be a better measure of ventricular preload and a more accurate reflection of degree of insufficiency.
Methods and results: Patients (n = 64) with magnetic resonance imaging after TOF repair were identified. PR was quantified using: (i) phase contrast (PC) analysis of main pulmonary artery flow and (ii) differential right and left ventricular stroke volumes. PR was expressed as a volume (PRvolume) and percentage of total forward flow (PRfraction). The median PCPR volume was 19 mL/m2 (range 0–63 mL/m2) and PCPR fraction was 29% (range 0–58%). PRfraction was found to be highly variable in terms of absolute PRvolume. In those with significant PR, PRvolume was better than PRfraction for the identification of severe RV dilation (receiver-operator curve area: 0.83 vs. 0.71, P = 0.003). PRvolume using PC analysis was better at differentiating moderate from severe RV dilation (P = 0.005) as compared with PRfraction (P = 0.064).
Conclusion: PRvolume and PRfraction are not interchangeable. PRvolume may be a more accurate reflection of RV preload and may better represent physiologically significant PR as compared with PRfraction.
Key Words: MRI • Tetralogy of Fallot • Pulmonary regurgitation
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