Published Online
on May 27, 2003

A more recent version of this article appeared on June 17, 2003

This Article Full Text (PDF) All Versions of this Article: 107/23/2938    most recent 01.CIR.0000077064.67790.5Bv1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kang, I-S. Articles by Yoo, S.-J. Search for Related Content PubMed PubMed Citation Articles by Kang, I-S. Articles by Yoo, S.-J. Related Collections Pulmonary circulation and disease CT and MRI Pediatric and congenital heart disease, including cardiovascular surgery

Submitted on December 30, 2002
Revised on March 20, 2003
Accepted on March 24, 2003

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, and 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.

^* To whom correspondence should be addressed. 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

This article has been cited by other articles:

				M. A. Harris, M. T. Cosulich, M. J. Gillespie, K. K. Whitehead, T. I. Liu, P. M. Weinberg, and M. A. Fogel Pre-Fontan cardiac magnetic resonance predicts post-Fontan length of stay and avoids ionizing radiation J. Thorac. Cardiovasc. Surg., October 1, 2009; 138(4): 941 - 947. [Abstract] [Full Text] [PDF]

				C. J. Petit, M. J. Gillespie, M. A. Harris, T. L. Seymour, T. Y. Liu, A. Khan, J. W. Gaynor, and J. J. Rome Relief of branch pulmonary artery stenosis reduces pulmonary valve insufficiency in a swine model. J. Thorac. Cardiovasc. Surg., August 1, 2009; 138(2): 382 - 389. [Abstract] [Full Text] [PDF]

				P. Lurz, J. Nordmeyer, V. Muthurangu, S. Khambadkone, G. Derrick, R. Yates, M. Sury, P. Bonhoeffer, and A. M. Taylor Comparison of Bare Metal Stenting and Percutaneous Pulmonary Valve Implantation for Treatment of Right Ventricular Outflow Tract Obstruction: Use of an X-Ray/Magnetic Resonance Hybrid Laboratory for Acute Physiological Assessment Circulation, June 16, 2009; 119(23): 2995 - 3001. [Abstract] [Full Text] [PDF]

				T. Urashima, M. Zhao, R. Wagner, G. Fajardo, S. Farahani, T. Quertermous, and D. Bernstein Molecular and physiological characterization of RV remodeling in a murine model of pulmonary stenosis Am J Physiol Heart Circ Physiol, September 1, 2008; 295(3): H1351 - H1368. [Abstract] [Full Text] [PDF]

				R. R Chaturvedi and A. N Redington Pulmonary regurgitation in congenital heart disease Heart, July 1, 2007; 93(7): 880 - 889. [Full Text] [PDF]

				M.-T. Wu, Y.-L. Huang, K.-S. Hsieh, J.-T. Huang, N.-J. Peng, J.-Y. Pan, J.-S. Huang, and T.-L. Yang Influence of Pulmonary Regurgitation Inequality on Differential Perfusion of the Lungs in Tetralogy of Fallot After Repair: A Phase-Contrast Magnetic Resonance Imaging and Perfusion Scintigraphy Study J. Am. Coll. Cardiol., May 8, 2007; 49(18): 1880 - 1886. [Abstract] [Full Text] [PDF]

				S Sridharan, G Derrick, J Deanfield, and A M Taylor Assessment of differential branch pulmonary blood flow: a comparative study of phase contrast magnetic resonance imaging and radionuclide lung perfusion imaging. Heart, July 1, 2006; 92(7): 963 - 968. [Abstract] [Full Text] [PDF]