title: Assessment of right ventricular diastolic function: does it predict post-operative course in tetralogy of Fallot.
abstract: BACKGROUND
  In some cases of tetralogy of Fallot the post-operative course is characterized by episodes of low cardiac output, elevated central filling pressures and prolonged ventilation and inotropic support. This may be due to impaired diastolic function of the right ventricle despite preservation of biventricular systolic function.
  
  
  RESULTS
  Sixty-four consecutive patients (mean age 7.06+/-4.9 years) undergoing repair of tetralogy of Fallot were prospectively studied to assess right ventricular diastolic function. 'Restrictive physiology' was defined as presence of laminar antegrade diastolic pulmonary artery flow (A wave) throughout the respiratory cycle, which was coincident with atrial systole. Right ventricle restriction was present in 45/64 (70%, Group 1) patients and absent in 19/64 (30%, Group 2) patients. There was a marked inspiratory augmentation of the pulmonary artery A wave velocity, flow integral and duration. Transtricuspid flow revealed significantly lower peak E velocity, lower E/A ratio, shorter E deceleration time and higher A velocity time integral in those with right ventricular restriction. Biventricular systolic function and transmitral flow were normal in all patients. Those with restrictive physiology had significantly longer mean inotrope support duration, longer ventilation and chest drainage times. Correspondingly, the mean intensive care unit stay (56.7+/-9.3 v. 34.7+/-5.38 hours, p<0.01) and mean hospital discharge time (9.3+/-2.3 v. 6.2+/-0.5 days, p <0.001) was also significantly longer in group 1.
  
  
  CONCLUSIONS
  Right ventricular restriction (as seen by laminar antegrade diastolic pulmonary artery flow throughout the respiratory cycle) exists in a significant subset of patients with tetralogy of Fallot following operative repair. Following surgery, such patients have higher inotropic requirement, longer ventilation times and longer hospital stay.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow.
authors.forename: Kaushlendra Singh
authors.initials: KS
authors.lastname: Rathore
authors.forename: Nirmal
authors.initials: N
authors.lastname: Gupta
authors.forename: Aditya
authors.initials: A
authors.lastname: Kapoor
authors.forename: Nitin
authors.initials: N
authors.lastname: Modi
authors.forename: P K
authors.initials: PK
authors.lastname: Singh
authors.forename: Prabhat
authors.initials: P
authors.lastname: Tewari
authors.forename: Nakul
authors.initials: N
authors.lastname: Sinha
mesh_terms: D000293:Adolescent; D000328:Adult; D001783:Blood Flow Velocity; D002648:Child; D002675:Child, Preschool; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D011182:Postoperative Care; D011379:Prognosis; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000503:physiopathology; D013771:Tetralogy of Fallot / Q000503:physiopathology / Q000601:surgery*; D016278:Ventricular Function, Right