Abstract 18292: Influence Of RV Diastolic Physiology On LV Diastolic Filling In Children After Tetralogy Of Fallot Repair. Restrictive RV Physiology Is Associated With Decreased LV Compliance
Background: Restrictive RV physiology is a common finding after Tetralogy of Fallot repair. RV filling characteristics may influence LV filling via diastolic ventriculo-ventricular interactions. The purpose of the current study was to study the effect of RV diastolic physiology on LV diastolic properties.
Methods: Retrospective study including 112 pediatric patients after TOF repair in infancy were identified from the database with comprehensive diastolic functional echocardiogram assessment between 2008–2010. Average age at time of study was 12.9 ± 3.2 years. Restrictive RV physiology was defined as the presence of antegrade flow in the main pulmonary artery during late diastole (with atrial contraction). LV diastolic function was assessed by studying mitral inflow patterns, pulmonary venous tracings and by pulsed tissue doppler velocities at the lateral mitral annulus. Data between groups were compared using Student's t-test.
Results: Of 112 pediatric patients identified, 58 had restrictive RV physiology (table 1). Patients with restrictive RV physiology had a larger RV short-axis dimension with a smaller LV end-diastolic dimension z-score than the non-restrictive group. The early LV diastolic parameters (MV E-wave velocity, IVRT, E'-velocity and E/E') were not significantly different between groups. Pulmonary venous S wave velocities were lower in the non-restrictive group while pulmonary venous D wave velocities were not different. In the restrictive RV group, pulmonary venous A-wave reversal velocity and A- wave duration were significantly different between groups.
Conclusion: RV restrictive physiology affects LV dimensions but does not affect LV early relaxation or early LV filling. However, the pronounced pulmonary vein A-wave reversal suggests LV compliance is reduced in patients with RV restriction following early TOF repair. This may be related to diastolic ventriculo-ventricular interactions in the late diastolic phase.
- © 2010 by American Heart Association, Inc.