P958Relation between right ventricular systolic function and right ventricular outflow tract pressure gradient in children after tetralogy of fallot correction.


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Abstract

Purpose: The aim of this study was to determine the relation between right ventricular systolic function and residual right ventricular outflow tract pressure gradient (RVOTPG) in children after tetralogy of Fallot (TOF) correction.Methods: 67 patients aged 6-18 years after TOF surgical repair, were examined. During first assessment (FA), history regarding time since surgical repair and an echocardiography with measurement of RVOTPG were performed. After 5 years since FA, during second assessment (SA), RVOTPG, tricuspid annular plane systolic excursion (TAPSE) and pulsed tissue Doppler peak velocity of the tricuspid annulus motion (S') were measured by echocardiography. RVOTPG was determined as a significant when was higher than 35 mmHg. We compared the RVOTPGs during FA and SA. Decrease of RVOTPG by 10 mmHg and RVOTPG below 35 mmHg was estimated as a significant. Statistical analysis using Pearson's correlation and Mann Whitney test were done.Results: During FA the time since surgical repair (TSSR) was at least 5 years, mean value 9,1 years±3,9. RVOTPG was 28,3mm Hg±15,1. Significant RVOTPG was measured in 27 patients, mean value 44,3 mmHg±10,5. Negative correlation between RVOTPG and TSSR (r=0,44,p<0,001) was detected.During SA mean RVOTPG was 22,9 mmHg±14,3; mean S' was 8,22 cm/s±1,9 and mean value of TAPSE was 14,63±2,34. From among patients with significant RVOTPG measured during FA, in 13 RVOTPG was consistently significant, mean value 45,4 mmHg±15,1, and in 14 RVOTPG decreased significantly up to mean value of 21,5 mmHg±6,2. In patients with consistently significant RVOTPG compared to patients with decreased RVOTPG, the mean value of S' was higher: 9,9cm/s±1,6 vs 6,5cm/s±0,8,p<0,05 and mean value of TAPSE was 15,4mm±1,9 vs 13,9mm±1,0,p=0,99.Conclusions: 1. In children after tetralogy of Fallot correction, pressure gradient between right ventricle and pulmonary artery decreases with time since surgical repair.2. During follow up, regional right ventricular systolic function expressed as the pulsed tissue Doppler peak velocity of the tricuspid annulus motion (S') is worse in children with decreasing of right ventricular outflow tract pressure gradient than in patients with constant right ventricular outflow tract pressure gradient after tetralogy of Fallot correction.3. Pulsed tissue Doppler peak velocity of the tricuspid annulus motion is more sensitive indicator of regional right ventricular systolic function than tricuspid annular plane systolic excursion in children after tetralogy of Fallot repair.

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