Clinical & Experimental Cardiology
Open Access

Abstract

Prediction of Pulmonary Regurge and Right Ventricular Function in Asymptomatic Repaired Tetralogy of Fallot Patients in Developing Countries: A Comparison to Cardiac Magnetic Resonance Imaging

Hala Agha, Doaa Mahgoub Aly, Fatma Alzahraa Moustafa, Ahmed Kharabish, Yasser Hussein Kamal, Gehan H Hussein, Lamiaa El- Zambely, Hassan El-Kiky, Mohamed Abd El-Raouf and Mohamed Youssef Abd El Rahman

Objective: To assess the value of conventional echocardiographic measurements for quantification of pulmonary regurge and right ventricular function in comparison to Cardiac Magnetic Resonance Imaging (CMR) after surgical repair of Tetralogy Of Fallot (TOF).

Methods: Twenty five asymptomatic children after TOF repair (9.2 ± 4 years) were compared to twenty five age matched healthy children. Echocardiographic quantification of pulmonary regurge was assessed by (1) pulmonary regurge jet width/pulmonary artery diameter, (2) pulmonary pressure half time, (3) pulmonary regurge index; pulmonary regurge duration to diastole duration, (4) no flow time; diastole duration - pulmonary regurge duration and (5) diastole/systole velocity time integral ratio. Measurements derived from conventional echocardiography were compared to pulmonary regurgitant fraction, right ventricular volumes and ejection fraction by CMR.

Results: On CMR, the pulmonary regurgitant fraction was 28.64 ± 10.2%. By conventional echocardiography, pulmonary regurge index and no flow time were found to offer the best prediction for severity of pulmonary regurge. Pulmonary regurge index of <0.8 has sensitivity of 86.36% and specificity of 100% (AUC=0.924) and no flow time of >64 msec has sensitivity of 81% and specificity of 100% (AUC=0.894) in identifying significant pulmonary regurge. Compared to controls, patients after TOF repair showed significantly lower right ventricle myocardial velocities, higher E/ E‘ ratio and prolonged MPI. Among the TOF patients, right ventricular MPI showed significant negative correlation (r=-0.402; P=0.008) with tricuspid valve annulus peak systolic velocity (S‘) and significant positive correlation (r= 0. 413; P=0.04) with right ventricle stroke volume by CMR.

Conclusion: Conventional echocardiography can offer a simple, readily available and accurate tool for quantification of pulmonary regurge and right ventricular function during mid- term follow up after surgical repair of tetralogy of Fallot.