title: The Impact of the Right Ventricular Outflow Tract Patch on Right Ventricular Strain in Tetralogy of Fallot: A Comparison with Valvar Pulmonary Stenosis Utilizing Cardiac Magnetic Resonance.
abstract: A non-contractile transannular patch (TAP) in the right ventricular outflow tract (RVOT) contributes to ventricular dysfunction after tetralogy of Fallot (TOF) repair. We compared regional right ventricular (RV) strain in repaired TOF with valvar pulmonary stenosis (VPS) after balloon valvuloplasty to investigate the effects of TAP. Retrospective review of 26 cardiac magnetic resonance studies of TOF (n = 13) and VPS (n = 13) subjects matched by degree and duration of pulmonary regurgitation (PR). Feature tracking strain analysis was performed. Student's t tests, Pearson correlation, and linear regression were applied. RV ejection fraction (EF) was normal and similar between TOF and VPS (60 and 65%, respectively, p = 0.8). RV 4-chamber Lagrangian longitudinal strain (RV 4ch LS) was worse in both groups compared to normals but comparable to each other: -18.2 (95% CI -3.6 to -33) for TOF and -20.2 (95% CI -12.4 to -28) for VPS, p = 0.5. RVOT LS was worse than RV 4ch LS in TOF, p = 0.05, but not in VPS, p = 0.19. There were no significant differences in RVOT strain between groups, p = 0.18. RVOT strain and RV 4ch LS correlated positively with RV EF in VPS (r = 0.72, p = 0.003 and r = 0.55, p = 0.04). PR degree correlated negatively with RVOT LS for TOF and VPS. Longitudinal strain is diminished in VPS and TOF subjects with preserved RV EF. TAP could explain worse RVOT strain in TOF. Longitudinal studies are needed to ascertain if RV strain predicts worsening of RV EF.
authors.affiliation: Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia PA. 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA. anwar_s@kids.wustl.edu.
authors.forename: Shafkat
authors.identifier: http://orcid.org/0000-0002-0001-8521
authors.initials: S
authors.lastname: Anwar
authors.affiliation: Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia PA. 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Harris
authors.affiliation: Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia PA. 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Whitehead
authors.affiliation: Division of Radiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia PA. 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
authors.forename: Marc S
authors.initials: MS
authors.lastname: Keller
authors.affiliation: Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia PA. 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Goldmuntz
authors.affiliation: Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia PA. 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Fogel
authors.affiliation: Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia PA. 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Mercer-Rosa
mesh_terms: D000293:Adolescent; D063126:Balloon Valvuloplasty; D002648:Child; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D016014:Linear Models; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D015143:Philadelphia; D011665:Pulmonary Valve Insufficiency / Q000000981:diagnostic imaging*; D011666:Pulmonary Valve Stenosis / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000601:surgery*; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging*
keywords: Cardiac MRI; Congenital heart disease; RV function; Strain