Surgery impacts right atrial function in tetralogy of Fallot

J Thorac Cardiovasc Surg. 2014 Apr;147(4):1306-11. doi: 10.1016/j.jtcvs.2013.06.020. Epub 2013 Jul 26.

Abstract

Objective: To analyze the impact of surgery and pericardial integrity on right atrial function and total heart volume variation in the setting of pulmonary valve insufficiency.

Methods: Right atrial function and total heart volume variation were analyzed in 2 subgroups of patients with pulmonary valve insufficiency compared with healthy controls: group 1 with surgically repaired tetralogy of Fallot (n = 20 patients) and group 2 after balloon angioplasty of pulmonary valve stenosis in patients with isolated valve disease without surgery (n = 7 patients). Volumetric analysis of magnetic resonance imaging data revealed parameters of atrial function (reservoir, conduit, and pump functions and cyclic volume change) and of total heart volume (end-diastolic and end-systolic total heart volume and the variation). Statistical analysis included uncorrected and corrected pairwise comparisons and the calculation of groupwise Pearson correlation coefficients.

Results: In group 1 with a pulmonary regurgitation fraction of 31.0% ± 14.9%, right atrial function was clearly impaired, with reduced reservoir and elevated conduit function, and total heart volume variation was elevated to 13.9% ± 3.4%. In group 2 with a pulmonary regurgitation fraction of 22.8% ± 6.9%, the values were close to normal, with unaffected atrial function and a total heart volume variation of 9.9% ± 3.3%.

Conclusions: The hydrodynamic effect of pulmonary valve insufficiency alone is likely not the only reason for impaired right atrial function and elevated total heart volume variation in patients with tetralogy of Fallot; it is rather the scar in the right atrium, the injured pericardium, and the disease itself that are responsible for the energetically unfavorable alterations.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Angioplasty, Balloon
  • Atrial Function, Right*
  • Female
  • Humans
  • Male
  • Pulmonary Valve Insufficiency / complications
  • Pulmonary Valve Insufficiency / surgery
  • Pulmonary Valve Stenosis / complications
  • Pulmonary Valve Stenosis / surgery
  • Tetralogy of Fallot / complications
  • Tetralogy of Fallot / physiopathology*
  • Tetralogy of Fallot / surgery*
  • Young Adult