title: Integrated analysis of atrioventricular interactions in tetralogy of Fallot.
abstract: The atria play an important role in cardiac performance. We evaluated their function and the atrioventricular interaction in operated patients with tetralogy of Fallot (TOF). Twenty patients who had undergone surgical repair of TOF and seven controls were investigated. Patients had residual pulmonary but no major tricuspid valve insufficiency. Atrial and ventricular strain rates were obtained by echocardiographic speckle tracking. Cine MRI-derived volumetric analysis provided atrial and ventricular time volume and time volume change curves yielding emptying and filling parameters. In addition, at the atrial level, reservoir, conduit and pump function, and cyclic volume change were calculated. At the atrioventricular valve level, tricuspid and mitral annular plane systolic excursion (TAPSE and MAPSE, respectively) were measured by two-dimensional echocardiography. In the patients compared with controls, right ventricular end-diastolic volumes were increased and biventricular ejection fraction was decreased (all P < 0.05). Biventricular measures of early diastolic ventricular filling were at control levels, but in late diastole, right ventricular filling parameters and strain rates were decreased (P < 0.001). The maximal right atrial size was slightly but not significantly diminished, but cyclic volume change was significantly reduced (P < 0.0001). Pump and reservoir function were decreased (P < 0.05), and conduit function was elevated (P < 0.001). The left atrium showed reduced reservoir function and cyclic volume change (P < 0.05). TAPSE and MAPSE were also decreased (P < 0.05). There were statistically significant interdependencies between RV ejection fraction, TAPSE, and right atrial filling and emptying parameters (all P < 0.05). In TOF patients, moderate systolic and diastolic right ventricular dysfunction is associated with clearly impaired right atrial function. The left atrium is affected to a lesser extent.
authors.affiliation: Deutsches Herzzentrum Berlin, Dept. of Congenital Heart Disease and Pediatric Cardiology, Augustenburger Platz 1, Berlin D-13353, Germany. riesenkampff@dhzb.de
authors.forename: Eugénie
authors.initials: E
authors.lastname: Riesenkampff
authors.forename: Lena
authors.initials: L
authors.lastname: Mengelkamp
authors.forename: Matthias
authors.initials: M
authors.lastname: Mueller
authors.forename: Siegfried
authors.initials: S
authors.lastname: Kropf
authors.forename: Hashim
authors.initials: H
authors.lastname: Abdul-Khaliq
authors.forename: Samir
authors.initials: S
authors.lastname: Sarikouch
authors.forename: Philipp
authors.initials: P
authors.lastname: Beerbaum
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
authors.forename: Paul
authors.initials: P
authors.lastname: Steendijk
authors.forename: Felix
authors.initials: F
authors.lastname: Berger
authors.forename: Titus
authors.initials: T
authors.lastname: Kuehne
mesh_terms: D000293:Adolescent; D000328:Adult; D016279:Atrial Function, Left; D016280:Atrial Function, Right; D006348:Cardiac Surgical Procedures; D016022:Case-Control Studies; D002648:Child; D003971:Diastole; D004452:Echocardiography; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D006351:Heart Valves / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D013318:Stroke Volume; D013599:Systole; D013771:Tetralogy of Fallot / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D013997:Time Factors; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D055815:Young Adult