The impact of preexisting myocardial remodeling on ventricular function early after tetralogy of Fallot repair.
BACKGROUND
Twenty-three patients (median age 23 months) who underwent Fallot's tetralogy repair were investigated prospectively to detect a possible association between histopathologic myocardial remodeling and echocardiographic findings of systolic or diastolic ventricular dysfunction.


METHODS
Intraoperatively resected infundibular bands and subendocardial biopsy samples from the right ventricle (RV) and left ventricle were obtained for histopathologic evaluation. Tissue Doppler echocardiographic interrogation of the ventricles was performed before surgery and in the postoperative period.


RESULTS
Histopathologic data revealed hypertrophy of the RV cardiomyocytes and increased interstitial collagen in both ventricles. Mean values of RV isovolumic acceleration decreased significantly at the third evaluation compared with the preoperative values (P = .006). RV myocardial fibrosis greater than 8.3% was associated with a probability of altered E' of at least 0.7 (odds ratio = 2.31).


CONCLUSIONS
Preoperative histologic myocardial remodeling influenced the postoperative RV function in this group of patients with late repair. Further studies are necessary to evaluate the myocardium in younger patients and to define its influence in the long-term follow-up.
Farah
Maria Cecília Knoll
MC
Medical School, Health and Biological Sciences Center, University of Mato Grosso, Brazil.
Castro
Cláudia Regina Pinheiro
CR
Moreira
Valéria de Melo
Vde M
Binotto
Maria Angélica
MA
Guerra
Vitor Coimbra
VC
Riso
Arlindo de Almeida
Ade A
Marcial
Miguel Barbero
MB
Lopes
Antonio Augusto
AA
Mathias
Wilson
W
Aiello
Vera Demarchi
VD
D000293:Adolescent; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003094:Collagen / Q000648:ultrastructure; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D004730:Endothelium, Vascular / Q000648:ultrastructure; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D032383:Myocytes, Cardiac / Q000648:ultrastructure; D011446:Prospective Studies; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric; D013771:Tetralogy of Fallot / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000601:surgery; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000601:surgery; D020257:Ventricular Remodeling
D003094:Collagen