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(Circulation. 2003;107:2938.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Differential Regurgitation in Branch Pulmonary Arteries After Repair of Tetralogy of Fallot

A Phase-Contrast Cine Magnetic Resonance Study

I-Seok Kang, MD; Andrew N. Redington, MD; Leland N. Benson, MD; Christopher Macgowan, PhD; Emanuela R. Valsangiacomo, MD; Kevin Roman, MD; Christian J. Kellenberger, MD; Shi-Joon Yoo, MD

From the Department of Diagnostic Imaging (C.M., K.R., C.J.K., S.-J.Y.) and Department of Pediatrics, Division of Cardiology (I.-S.K., A.N.R., L.N.B., K.R., S.-J.Y.), The University of Toronto School of Medicine, the Hospital for Sick Children, Toronto, Ontario, Canada, and the Department of Pediatrics (E.R.V.), University Children’s Hospital Zurich, Zurich, Switzerland.

Correspondence to Shi-Joon Yoo, MD, Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8. E-mail shi-joon.yoo{at}sickkids.ca

Background— The importance of pulmonary regurgitation (PR) after repair of tetralogy of Fallot (TOF) is increasingly recognized, but little is known regarding its underlying mechanisms. This phase-contrast cine magnetic resonance (PC MR) study was performed to evaluate the relative contribution of each lung to total regurgitant volume.

Methods and Results— Twenty-two patients with significant PR underwent a PC MR 3 to 16 years after repair of TOF. Regurgitant fraction of the main pulmonary artery was 39±10%. Regurgitant fraction of the left pulmonary artery (LPA; 46±18%) was greater than that of the right pulmonary artery (34±16%; P=0.002). The average contribution of the LPA to the total regurgitant flow volume was 54±19%, whereas its average contribution to the total forward flow volume was 44±13% (P=0.002). In 4 patients, regurgitant flow in the LPA accounted for 75% to 100% of the total regurgitant flow. There was a linear relationship between regurgitant fraction and fraction of the regurgitant flow duration in the main pulmonary artery (P<0.001) and right pulmonary artery (P=0.001) but not in the LPA (P=0.129).

Conclusions— PR after repair of TOF is commonly associated with differential regurgitation in the branch pulmonary arteries, which is usually greater in the LPA. Although the cause of this disparity requires further investigation, those patients with a significant unilateral contribution to total PR may be amenable to localized techniques to reduce regurgitation.

Key Words: regurgitation • arteries • tetralogy of Fallot • magnetic resonance imaging • heart defects, congenital

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