Integrated analysis of atrioventricular interactions in tetralogy of Fallot

Am J Physiol Heart Circ Physiol. 2010 Aug;299(2):H364-71. doi: 10.1152/ajpheart.00264.2010. Epub 2010 May 21.


The atria play an important role in cardiac performance. We evaluated their function and the atrioventricular interaction in operated patients with tetralogy of Fallot (TOF). Twenty patients who had undergone surgical repair of TOF and seven controls were investigated. Patients had residual pulmonary but no major tricuspid valve insufficiency. Atrial and ventricular strain rates were obtained by echocardiographic speckle tracking. Cine MRI-derived volumetric analysis provided atrial and ventricular time volume and time volume change curves yielding emptying and filling parameters. In addition, at the atrial level, reservoir, conduit and pump function, and cyclic volume change were calculated. At the atrioventricular valve level, tricuspid and mitral annular plane systolic excursion (TAPSE and MAPSE, respectively) were measured by two-dimensional echocardiography. In the patients compared with controls, right ventricular end-diastolic volumes were increased and biventricular ejection fraction was decreased (all P < 0.05). Biventricular measures of early diastolic ventricular filling were at control levels, but in late diastole, right ventricular filling parameters and strain rates were decreased (P < 0.001). The maximal right atrial size was slightly but not significantly diminished, but cyclic volume change was significantly reduced (P < 0.0001). Pump and reservoir function were decreased (P < 0.05), and conduit function was elevated (P < 0.001). The left atrium showed reduced reservoir function and cyclic volume change (P < 0.05). TAPSE and MAPSE were also decreased (P < 0.05). There were statistically significant interdependencies between RV ejection fraction, TAPSE, and right atrial filling and emptying parameters (all P < 0.05). In TOF patients, moderate systolic and diastolic right ventricular dysfunction is associated with clearly impaired right atrial function. The left atrium is affected to a lesser extent.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Atrial Function, Left*
  • Atrial Function, Right*
  • Cardiac Surgical Procedures
  • Case-Control Studies
  • Child
  • Diastole
  • Echocardiography
  • Female
  • Heart Atria / diagnostic imaging
  • Heart Atria / physiopathology*
  • Heart Atria / surgery
  • Heart Valves / physiopathology
  • Heart Ventricles / diagnostic imaging
  • Heart Ventricles / physiopathology*
  • Heart Ventricles / surgery
  • Humans
  • Magnetic Resonance Imaging, Cine
  • Male
  • Stroke Volume
  • Systole
  • Tetralogy of Fallot / diagnosis
  • Tetralogy of Fallot / physiopathology*
  • Tetralogy of Fallot / surgery
  • Time Factors
  • Ventricular Function, Left*
  • Ventricular Function, Right*
  • Young Adult