Abstract 19447: Correlation of Early Echocardiographic Right Ventricular Dimension and MRI Right Ventricular Volumes Late After Tetralogy of Fallot Repair
Introduction: Right Ventricular End-Diastolic Volume indexed (RVEDVi) obtained by MRI is an accurate measure of RV size and a marker for secondary complications. Echo RV measurements are used early in life after TOF repair for practical reasons. We sought to examine the correlation between early echo Right Ventricular End-Diastolic Dimension z-score (RVEDDz) and MRI RVEDVi at 15 years post-repair. The relationship between these parameters and repair technique is investigated.
Methods: 185 TOF patients were repaired at our institution from 1996-2002. Repair techniques were: annulus preservation (AP=124), trans-annular patch (TAP=56), and Pulmonary valve replacement (n=5, patients excluded). Data was reviewed for outcomes, echo studies, and MRI reports. A linear ordinary least square model demonstrated the relationship between early RVEDDz and late RVEDVi (n=57) . Longitudinal analysis with mixed effects model was performed on 783 serial echocardiograms (n=146) to demonstrate the effect of technique on RVEDDz progression.
Results: RVEDDz at 1-5 years post-repair was a significant predicator for late RVEDVi (p=0.0016). A change in RVEDDz from 0-3 predicted an increase in RVEDVi of 28 mL. TAP repair was an independent predictor of a larger RVEDVi (p=0.0011). TAP was associated with more RV dilation throughout follow-up (0.37 RVEDDz higher every 5 years, p<0.0001). TAP patients had larger late RV volumes for the same early RVEDDz as those with AP repair (Fig. 1). The same findings were demonstrated in a sub-analysis of anatomically matched patients who could have had either TAP or AP based on surgeon choice.
Conclusion: These results from a single institution support the use of RVEDDz by echo as an early maker for late MRI RV volumes in TOF. Early identification of high risk patients may influence decisions around follow-up and re-interventions. Larger population studies are needed to confirm these findings and the effects of technique on long-term RV health.
Author Disclosures: S. Hussain: None. O. Al-Radi: None. P. Pondorfer: None. L. Grosse-Wortmann: None. L. Mertens: None. G. Van Arsdell: None.
- © 2015 by American Heart Association, Inc.