Echocardiographic assessment after surgical repair of tetralogy of fallot

Mario Carminati, Francesca R Pluchinotta, Luciane Piazza, Angelo Micheletti, Diana Negura, Massimo Chessa, Gianfranco Butera, Carmelo Arcidiacono, Antonio Saracino, Claudio Bussadori, Mario Carminati, Francesca R Pluchinotta, Luciane Piazza, Angelo Micheletti, Diana Negura, Massimo Chessa, Gianfranco Butera, Carmelo Arcidiacono, Antonio Saracino, Claudio Bussadori

Abstract

Surgical correction of tetralogy of Fallot is still one of the most frequently performed intervention in pediatric cardiac surgery, and in many cases, it is far from being a complete and definitive correction. It is rather an excellent palliation that solves the problem of cyanosis, but predisposes the patients to medical and surgical complications during follow-up. The decision-making process regarding the treatment of late sequel is among the most discussed topics in adult congenital cardiology. In post-operative Fallot patients, echocardiography is used as the first method of diagnostic imaging and currently allows both a qualitative observation of the anatomical alterations and a detailed quantification of right ventricular volumes and function, of the right ventricular outflow tract, and of the pulmonary valve and pulmonary arteries. The literature introduced many quantitative echocardiographic criteria useful for the understanding of the pathophysiological mechanisms involving the right ventricle and those have made much more objective any decision-making processes.

Keywords: cardiac surgical procedures; echocardiography; right ventricular dysfunction; strain rate; tetralogy of Fallot.

Figures

Figure 1
Figure 1
The dotted arrow indicates the position where to measure the RVOT diameter.
Figure 2
Figure 2
Eighteen year-old man with a restrictive right ventricle, low value of TAPSE: 6 mm.
Figure 3
Figure 3
Thirty year-old woman with severe pulmonary regurgitation. (A) High value of TAPSE (22 mm) due to the volume overload. (B) Normalization of TAPSE 24 h after percutaneous implantation of a pulmonary prosthetic valve.
Figure 4
Figure 4
The first rapid systolic wave represents the isovolumic contraction. The pendency of the curve estimates the isovolumic acceleration.
Figure 5
Figure 5
High values of strain at the basal segment of lateral right ventricular wall.
Figure 6
Figure 6
High values of transversal strain in a ToF operated patient with restrictive RV.
Figure 7
Figure 7
Severe pulmonary insufficiency with early end and low values of pulmonary pressure half time (PHT).
Figure 8
Figure 8
The arrow indicates the end-diastolic forward flow.

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