title: CMR assessment of right ventricular function in patients with combined pulmonary stenosis and insufficiency after correction of tetralogy of Fallot.
abstract: BACKGROUND
  Tetralogy of Fallot (TOF) is one of the most common types of congenital heart disease and requires prompt surgical correction. Post-correction pulmonary insufficiency (PI) often ensues in adulthood. At times, the PI is accompanied by residual pulmonary stenosis (PS). Little is known regarding right ventricular (RV) function in the setting of combined PS and PI.
  
  
  OBJECTIVE
  To compare cardiac magnetic resonance (CMR) parameters for the assessment of RV function between patients with combined pulmonary stenosis and pulmonary insufficiency (PSPI) and isolated PI following surgical repair of TOF.
  
  
  METHODS
  Retrospective review of patients with comparable corrected TOF and similar PI was performed. Seventeen patients (median age, 24 years; range, 10-52 years) had combined PSPI and 30 patients (median age, 30 years; range, 6-70 years) had isolated PI. Cine magnetic resonance (MR) images (Philips Medical Systems, Best, The Netherlands) in the short-axis plane were used to calculate end-systolic, end-diastolic, and stroke volumes (RVESV, RVEDV, RVSV) and to measure RV wall thickness. Velocity-encoded cine MR images were used to measure pulmonary regurgitation fraction (PRF) by calculating the ratio of backward flow and total forward flow, obtained from the main pulmonary flow analysis. Peak pressure gradient across the pulmonary valve was obtained from spectral Doppler echocardiography.
  
  
  RESULTS
  RVEF was 51 ± 8% in the PSPI patients and 39 ± 11%, in the patients with isolated PI (P = 0.001). Additionally, RV wall thickness was 5.2 ± 0.8 mm in the PSPI patients compared to 2.6 ± 0.9 mm in the isolated PI patients (P = 0.001). RVESVi and RVEDVi were significantly lower (P < 0.05) in patients with combined PSPI (60 ± 21 mL/m(2), 121 ± 35 mL/m(2), respectively) compared to the patients with isolated PI (95 ± 48 mL/m(2), 152 ± 61 mL/m(2), respectively).
  
  
  CONCLUSIONS
  RV function is preserved in patients with PSPI when compared to patients with PI following surgical repair of TOF.
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
authors.forename: Maureen P
authors.initials: MP
authors.lastname: Kohi
authors.forename: Karen G
authors.initials: KG
authors.lastname: Ordovas
authors.forename: David M
authors.initials: DM
authors.lastname: Naeger
authors.forename: Alison Knauth
authors.initials: AK
authors.lastname: Meadows
authors.forename: Elyse
authors.initials: E
authors.lastname: Foster
authors.forename: Charles B
authors.initials: CB
authors.lastname: Higgins
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008875:Middle Aged; D011183:Postoperative Complications; D011665:Pulmonary Valve Insufficiency / Q000150:complications / Q000503:physiopathology*; D011666:Pulmonary Valve Stenosis / Q000150:complications / Q000503:physiopathology*; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000150:complications* / Q000601:surgery*; D016278:Ventricular Function, Right / Q000502:physiology*
keywords: Cardiac; anatomy; congenital; heart; magnetic resonance imaging (MRI); pediatrics