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
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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
![]()
CiteULike
Connotea
Del.icio.us What's this?
This article has been cited by other articles:
![]() |
J. Kjaergaard, K. K. Iversen, N. G. Vejlstrup, J. Smith, P. Bonhoeffer, L. Sondergaard, and C. Hassager Impacts of acute severe pulmonary regurgitation on right ventricular geometry and contractility assessed by tissue-Doppler echocardiography Eur J Echocardiogr, October 6, 2009; (2009) jep149v1. [Abstract] [Full Text] [PDF] |
||||
![]() |
L. Grosse-Wortmann and A. Redington Doing the right thing at the right time: is there more to pulmonary valve replacement than meets the eye? Eur. Heart J., September 1, 2009; 30(17): 2076 - 2078. [Full Text] [PDF] |
||||
![]() |
M. Spiewak, L. A. Malek, and J. Misko Right ventricular outflow tract obstruction should be considered in assessing influence of pulmonary regurgitation on right ventricular volume Eur. Heart J., July 2, 2009; 30(14): 1807 - 1807. [Full Text] [PDF] |
||||
![]() |
R. M. Wald, A. N. Redington, A. Pereira, Y. L. Provost, N. S. Paul, E. N. Oechslin, and C. K. Silversides Right ventricular outflow tract obstruction should be considered in assessing influence of pulmonary regurgitation on right ventricular volumes: reply Eur. Heart J., July 2, 2009; 30(14): 1807 - 1808. [Full Text] [PDF] |
||||

