Letter by DeGroff Regarding Article, “Direction of Preoperative Ventricular Shunting Affects Ventricular Mechanics After Tetralogy of Fallot Repair”
To the Editor:
I enjoyed the work presented recently in Circulation by Richmond et al1 entitled “Direction of Preoperative Ventricular Shunting Affects Ventricular Mechanics After Tetralogy of Fallot Repair.” However, a major limitation of this work was not discussed in the detail it deserves. The authors use of 2-dimensional echocardiographic “stroke area” of the left ventricle has a number of significant limitations in the assessment of myocardial contractile state, many of which should have been at least mentioned in the article. One simple imaging limitation of this method has particular significance here because of the subjects included in this study (ie, subjects with right and left volume- or pressure-overloaded ventricles). This limitation was described elegantly more than a decade ago by Matsumori et al.2 Matsumori et al illustrated the effects of right ventricular volume and pressure overloads on assessment of left ventricular volume with the use of 2-dimensional echocardiographic methods. This raises the concern that the differences that Richmond et al are seeing between patient groups are simply effects from limitations of the technique itself.
Richmond ME, Cabreriza SE, Van Batavia JP, Quinn TA, Kanter JP, Weinberg AD, Mosca RS, Quaegebeur JM, Spotnitz HM. Direction of preoperative ventricular shunting affects ventricular mechanics after tetralogy of Fallot repair. Circulation. 2008; 118: 2338–2344.
Matsumori M, Ito T, Toyono M, Harada K, Takada G. Influence of right ventricular volume and pressure overloads on assessment of left ventricular volume using two-dimensional echocardiography in infants and children with congenital heart diseases. Am J Cardiol. 1997; 80: 965–968.