Right ventricular restrictive physiology in repaired tetralogy of Fallot is associated with smaller respiratory variability.
BACKGROUND
Long-term outcomes of patients with repaired tetralogy of Fallot (TOF) are known to be related with right ventricular (RV) volume overload, severity of pulmonary insufficiency (PI) and the type of outflow repair. Right ventricular restrictive physiology (RVRP) has also been reported to interfere with several factors influencing the late result in repaired TOF patients. However, the mechanism and physiology of this unique myocardial property in the chronically overloaded right ventricle are not yet clearly understood.


METHODS
We investigated 43 patients after repair of TOF to assess the relationships among biventricular diastolic function, volume characteristics, and influence of respiratory effort. The patients were classified into 3 groups; 15 patients with RVRP and significant PI (RP group, 35%), 19 without RVRP in the presence of significant PI (NR+PI group, 44%), and 9 without RP or significant PI (NR-PI group, 21%). Doppler spectrals obtained by echocardiography from systemic and pulmonary veins, main pulmonary artery (MPA), and both ventricular inlets, and biventricular diastolic function were compared according to the respiratory cycle.


RESULTS
The RP group revealed higher pulmonary venous systolic/diastolic flow ratio (S/D ratio) and the NR+PI group showed larger velocity-time integral (VTI) ratio of total regurgitant/antegrade flow at the MPA and more respiratory variability in the systemic vein.


CONCLUSIONS
RP is associated with less volume overload of the RV and smaller respiratory variability is also associated with the restrictive RV. The diastolic function and volume status of the RV may influence the diastolic properties of the left heart.
Choi
Jae Young
JY
Division of Pediatric Cardiology, Cardiovascular Center, Yonsei University College of Medicine, 134 Shinchon-Dong, Seodaemun-Ku, 120-752, C.P.O. Box 8044, Seoul, Republic of Korea. cjy0122@yumc.yonsei.ac.kr
Kwon
Hae Sik
HS
Yoo
Byung Won
BW
Shin
Jae Il
JI
Sul
Jun Hee
JH
Park
Han Ki
HK
Park
Young Hwan
YH
D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012129:Respiratory Function Tests; D012140:Respiratory Tract Diseases / Q000209:etiology* / Q000503:physiopathology; D013771:Tetralogy of Fallot / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D014463:Ultrasonography; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology*