title: Exercise MR imaging in the assessment of pulmonary regurgitation and biventricular function in patients after tetralogy of fallot repair.
abstract: OBJECTIVE
  To assess the responses of pulmonary regurgitation (PR) and biventricular function to submaximal exercise by using a magnetic resonance (MR) imaging exercise protocol with young adult patients who underwent tetralogy of Fallot repair at a young age.
  
  
  METHODS
  Fifteen patients with corrected tetralogy of Fallot (mean age, 17.5 years +/- 2.5 [SD]) underwent MR imaging at rest and during exercise for the evaluation of PR and biventricular function. Results were compared with findings from 16 control subjects (mean age, 17.5 years +/- 2.3). Mean age at tetralogy of Fallot repair was 2.1 years +/- 1.6, and mean follow-up time after repair was 15.4 years +/- 2.6. Exercise level at MR imaging was calculated individually and corresponded to 60% of peak oxygen uptake. The parameters of cardiac function obtained at rest and during exercise were compared by using a paired t test. An unpaired t test was used to compare parameters of cardiac function between patients and control subjects.
  
  
  RESULTS
  PR decreased during exercise (from 27 mL/m(2) +/- 17 to 23 mL/m(2) +/- 15; P =.012). At rest, right ventricular (RV) ejection fraction was normal (>47%) in 80% of patients. RV response to exercise in the patient group was abnormal compared with response in the control group, as demonstrated by an increase in RV end-diastolic volume index (132 mL/m(2) +/- 36 to 137 mL/m(2) +/- 38; P =.041) and no significant change in end-systolic volume index or ejection fraction. In only one patient, RV ejection fraction increased by more than 5%. Left ventricular response was not different between patients and control subjects.
  
  
  CONCLUSIONS
  MR imaging is well suited to assess cardiac response to exercise, and findings revealed a decrease in PR and an abnormal RV response to exercise in patients with corrected tetralogy of Fallot.
authors.affiliation: Department of Pediatric Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
authors.forename: Arno A W
authors.initials: AA
authors.lastname: Roest
authors.forename: Willem A
authors.initials: WA
authors.lastname: Helbing
authors.forename: Patrik
authors.initials: P
authors.lastname: Kunz
authors.forename: Joost G
authors.initials: JG
authors.lastname: van den Aardweg
authors.forename: Hildo J
authors.initials: HJ
authors.lastname: Lamb
authors.forename: Hubert W
authors.initials: HW
authors.lastname: Vliegen
authors.forename: Ernst E
authors.initials: EE
authors.lastname: van der Wall
authors.forename: Albert
authors.initials: A
authors.lastname: de Roos
mesh_terms: D000293:Adolescent; D000328:Adult; D005080:Exercise Test; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011182:Postoperative Care; D011183:Postoperative Complications / Q000473:pathology* / Q000503:physiopathology*; D011665:Pulmonary Valve Insufficiency / Q000473:pathology* / Q000503:physiopathology*; D013771:Tetralogy of Fallot / Q000601:surgery*; D018754:Ventricular Dysfunction / Q000473:pathology* / Q000503:physiopathology*