title: Long-term follow-up in repaired tetralogy of fallot: can deformation imaging help identify optimal timing of pulmonary valve replacement?
abstract: BACKGROUND
  Novel echocardiographic techniques based on myocardial deformation have not been extensively evaluated to assess right ventricular (RV) and left ventricular (LV) response after pulmonary valve replacement (PVR) in patients with repaired tetralogy of Fallot.
  
  
  METHODS
  Between 2003 and 2012, 133 patients undergoing first-time PVR after tetralogy of Fallot repair underwent echocardiographic assessment at Mayo Clinic. The last echocardiogram before PVR and 1 year after surgery were retrospectively analyzed with Velocity Vector Imaging.
  
  
  RESULTS
  Mean age at PVR was 35.5 ± 16.2 years (54% women). Longitudinal peak systolic strain and strain rate before PVR were low: for the left ventricle, -14.8 ± 3.5% and -0.8 ± 0.2 sec(-1), and for the right ventricle, -16.2 ± 4.1% and -0.9 ± 0.3 sec(-1), respectively. There was no significant change in either parameter after surgery. A close correlation between LV and RV deformational parameters was found before PVR and was maintained after surgery. In the multivariate analysis, patients with better LV and RV peak systolic strain preoperatively were found to have better LV and RV peak systolic strain after surgery (P = .004 and P = .006, respectively). However, patients with the most improvement in deformation were those with worse RV function preoperatively (P = .002). Mean New York Heart Association class at early follow-up improved from 2.2 ± 0.8 to 1.2 ± 0.6 (P < .0001); RV peak systolic strain was the only factor associated with symptomatic improvement.
  
  
  CONCLUSIONS
  LV and RV systolic and diastolic deformational parameters were decreased in patients with repaired tetralogy of Fallot undergoing PVR, and there was no significant change after surgery. However, preoperative systolic deformational parameters were predictive of postoperative ventricular function and New York Heart Association class after PVR and may be helpful to identify optimal timing for surgical intervention in this cohort.
authors.affiliation: Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota; Universitat Autònoma de Barcelona, Mayo Clinic, Rochester, Minnesota.
authors.forename: Anna
authors.initials: A
authors.lastname: Sabate Rotes
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Crystal R
authors.initials: CR
authors.lastname: Bonnichsen
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Chelsea L
authors.initials: CL
authors.lastname: Reece
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Connolly
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Harold M
authors.initials: HM
authors.lastname: Burkhart
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Dearani
authors.affiliation: Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota. Electronic address: eidem.benjamin@mayo.edu.
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Eidem
mesh_terms: D000328:Adult; D002675:Child, Preschool; D004452:Echocardiography / Q000379:methods*; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D018579:Patient Selection; D011379:Prognosis; D011665:Pulmonary Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013771:Tetralogy of Fallot / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Magnetic resonance imaging; Pulmonary valve replacement; Strain echocardiography; Tetralogy of Fallot