This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map 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 Babu-Narayan, S. V. Articles by Gatzoulis, M. A. Search for Related Content PubMed PubMed Citation Articles by Babu-Narayan, S. V. Articles by Gatzoulis, M. A. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Heart Diseases MRI Scans Related Collections CT and MRI Pediatric and congenital heart disease, including cardiovascular surgery Arrhythmias, clinical electrophysiology, drugs

(Circulation. 2006;113:405-413.)
© 2006 American Heart Association, Inc.

Imaging

Ventricular Fibrosis Suggested by Cardiovascular Magnetic Resonance in Adults With Repaired Tetralogy of Fallot and Its Relationship to Adverse Markers of Clinical Outcome

Sonya V. Babu-Narayan, BSc, MRCP; Philip J. Kilner, MD, PhD; Wei Li, MD, PhD; James C. Moon, MRCP; Omer Goktekin, MD; Periklis A. Davlouros, MD; Mohammed Khan, MPH; Siew Yen Ho, PhD, FRCPath; Dudley J. Pennell, MD, FRCP; Michael A. Gatzoulis, MD, PhD

From the Adult Congenital Heart Unit (S.V.B.-N., W.L., O.G., P.A.D., M.A.G.) and the Cardiovascular Magnetic Resonance Unit (S.V.B.-N., P.J.K., J.C.M., D.J.P.), Royal Brompton Hospital, London, United Kingdom; and the National Heart and Lung Institute (S.V.B.-N., P.J.K., W.L., M.K., S.Y.H., D.J.P., M.A.G.), Imperial College, London, United Kingdom.

Correspondence to Dr Sonya V. Babu-Narayan, Adult Congenital Heart Unit, Royal Brompton Hospital, Sydney St, London SW3 6NP, United Kingdom. E-mail sonya{at}doctors.org.uk

Received March 11, 2005; revision received October 28, 2005; accepted November 21, 2005.

Background— Late morbidity and mortality remain problematic after repair of tetralogy of Fallot (TOF). We hypothesized that fibrosis detected by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) would be present in adults with repaired TOF and would be related to adverse markers of outcome.

Method and Results— LGE was scored in the right and left ventricles (RV and LV) of 92 adult patients who had undergone TOF repair. RV LGE was seen in all patients at surgical sites located in the outflow tract (99%) or the site of ventricular septal defect patching (98%) and in the inferior RV insertion point (79%) and trabeculated myocardium (24%). LV LGE (53%) was located at the apex consistent with apical vent insertion (49%), in the inferior or lateral wall consistent with infarction (5%), or in other areas (8%). Patients with supramedian RV LGE score were older (38 versus 27 years, P<0.001) and more symptomatic (38% versus 8% in New York Heart Association class II or greater, P=0.001), had increased levels of atrial natriuretic peptide (7.3 versus 4.9 pmol/L, P=0.041), and had a trend to higher brain natriuretic peptide (12.3 versus 7.2 pmol/L, P=0.086), exercise intolerance (maximum O₂ 24 versus 28 mL · min^–1 · kg^–1, P=0.021), RV dysfunction (RV end-systolic volume 61 versus 55 mL/m², P=0.018; RV ejection fraction 50% versus 56%, P=0.007), and clinical arrhythmia (26% versus 10%, P=0.039). Non–apical vent LV LGE also correlated with markers of adverse outcome. In a multivariate model, RV LGE remained a predictor of arrhythmia.

Conclusions— RV and LV LGE were common after TOF repair and were related to adverse clinical markers, including ventricular dysfunction, exercise intolerance, and neurohormonal activation. Furthermore, RV LGE was significantly associated with clinical arrhythmia.

---

 

CLINICAL PERSPECTIVE

This article has been cited by other articles:

				A. Frigiola, V. Tsang, C. Bull, L. Coats, S. Khambadkone, G. Derrick, B. Mist, F. Walker, C. van Doorn, P. Bonhoeffer, et al. Biventricular Response After Pulmonary Valve Replacement for Right Ventricular Outflow Tract Dysfunction: Is Age a Predictor of Outcome? Circulation, September 30, 2008; 118(14_suppl_1): S182 - S190. [Abstract] [Full Text] [PDF]

				P. Bordachar, X. Iriart, J. Chabaneix, F. Sacher, S. Lafitte, P. Jais, M. Haissaguerre, J. Clementy, P. Dos Santos, and J.-B. Thambo Presence of ventricular dyssynchrony and haemodynamic impact of right ventricular pacing in adults with repaired Tetralogy of Fallot and right bundle branch block Europace, July 4, 2008; (2008) eun178v1. [Abstract] [Full Text] [PDF]

				K. K. Witte, C. B. Pepper, J. C. Cowan, J. D. Thomson, K. M. English, and M. E. Blackburn Implantable cardioverter-defibrillator therapy in adult patients with tetralogy of Fallot Europace, April 28, 2008; (2008) eun108v1. [Abstract] [Full Text] [PDF]

				A. Crean Cardiovascular MR and CT in congenital heart disease Heart, December 1, 2007; 93(12): 1637 - 1647. [Full Text] [PDF]

				G.-P. Diller, K. Dimopoulos, H. Kafka, S. Y. Ho, and M. A. Gatzoulis Model of chronic adaptation: right ventricular function in Eisenmenger syndrome Eur. Heart J. Suppl., December 1, 2007; 9(suppl_H): H54 - H60. [Abstract] [Full Text] [PDF]

				Y.-Y. Lam, M. G. Kaya, O. Goktekin, M. A. Gatzoulis, W. Li, and M. Y. Henein Restrictive Right Ventricular Physiology: Its Presence and Symptomatic Contribution in Patients With Pulmonary Valvular Stenosis J. Am. Coll. Cardiol., October 9, 2007; 50(15): 1491 - 1497. [Abstract] [Full Text] [PDF]

				A. Uebing, D. G. Gibson, S. V. Babu-Narayan, G. P. Diller, K. Dimopoulos, O. Goktekin, M. S. Spence, K. Andersen, M. Y. Henein, M. A. Gatzoulis, et al. Right Ventricular Mechanics and QRS Duration in Patients With Repaired Tetralogy of Fallot: Implications of Infundibular Disease Circulation, October 2, 2007; 116(14): 1532 - 1539. [Abstract] [Full Text] [PDF]

				I. R. Henkens, A. van Straten, M. J. Schalij, M. G. Hazekamp, A. de Roos, E. E. van der Wall, and H. W. Vliegen Predicting Outcome of Pulmonary Valve Replacement in Adult Tetralogy of Fallot Patients Ann. Thorac. Surg., March 1, 2007; 83(3): 907 - 911. [Abstract] [Full Text] [PDF]

				M. A. Harris, T. R. Johnson, P. M. Weinberg, and M. A. Fogel Delayed-enhancement cardiovascular magnetic resonance identifies fibrous tissue in children after surgery for congenital heart disease J. Thorac. Cardiovasc. Surg., March 1, 2007; 133(3): 676 - 681. [Abstract] [Full Text] [PDF]

				G. P. McCann, C. T. Gan, A. M. Beek, H. W. M. Niessen, A. V. Noordegraaf, and A. C. van Rossum Extent of MRI Delayed Enhancement of Myocardial Mass Is Related to Right Ventricular Dysfunction in Pulmonary Artery Hypertension Am. J. Roentgenol., February 1, 2007; 188(2): 349 - 355. [Abstract] [Full Text] [PDF]

				A. Ooi, N. Moorjani, G. Baliulis, B. R. Keeton, A. P. Salmon, J. L. Monro, and M. P. Haw Medium term outcome for infant repair in tetralogy of Fallot: indicators for timing of surgery Eur. J. Cardiothorac. Surg., December 1, 2006; 30(6): 917 - 922. [Abstract] [Full Text] [PDF]

				E. A Shinebourne, S. V Babu-Narayan, and J. S Carvalho Tetralogy of Fallot: from fetus to adult. Heart, September 1, 2006; 92(9): 1353 - 1359. [Full Text] [PDF]