Yoshiki Mori1, Tomotaka Murakami2, Nao Inoue2, Sachie Kaneko2, Yasumi Nakashima2, Masaaki Koide3. 1. Seirei Hamamatsu General Hospital, Division of Pediatric Cardiology, Japan. Electronic address: y.mori@sis.seirei.or.jp. 2. Seirei Hamamatsu General Hospital, Division of Pediatric Cardiology, Japan. 3. Seirei Hamamatsu General Hospital, Department of Cardiovascular Surgery, Japan.
Abstract
BACKGROUND: End-diastolic forward flow (EDFF) is recognized as restrictive right ventricular physiology (r-RVP), but conflicting results have been reported about effects on the clinical outcome in repaired tetralogy of Fallot (r-TOF). OBJECTIVES: We hypothesized that the EDFF by Doppler was not specific for diagnosing r-RVP. METHODS: Sixty-two consecutive patients aged 15.7±11.6years who underwent cardiac catheterization were studied. Patients were divided according to the presence of EDFF (group 1: EDFF+, group 2: EDFF-) and RV size (group A: small RV, group B: large RV [>150ml/m2]). RESULTS: Group 1 (n=23) had higher a right atrial pressure (RAP), pressure gradient between the RAP and pulmonary diastolic pressure (PDP), and atrial natriuretic peptide (ANP) levels than group 2. Four patients (17.4%) in group 1 and 89.7% of patients in group 2 had a normal RAP range (a wave<10mmHg). There were no differences in the RV volume, ejection fraction (EF), B-type natriuretic peptide levels, and severity of pulmonary regurgitation (PR) between groups 1 and 2. Group A had better RV and LVEF than group B, as well as a smaller LV size. The RAP in subgroup 1A was higher than that of the other 3 subgroups. Subgroup 1B had a similar RAP to group 2, and a lower PDP and a more severe PR than subgroup 1A. CONCLUSIONS: Patients with EDFF are associated with increased ANP levels. The presence of EDFF may not be specific for r-RVP, since it is observed in some TOF patients with low PDP (severe PR) and normal RAP.
BACKGROUND: End-diastolic forward flow (EDFF) is recognized as restrictive right ventricular physiology (r-RVP), but conflicting results have been reported about effects on the clinical outcome in repaired tetralogy of Fallot (r-TOF). OBJECTIVES: We hypothesized that the EDFF by Doppler was not specific for diagnosing r-RVP. METHODS: Sixty-two consecutive patients aged 15.7±11.6years who underwent cardiac catheterization were studied. Patients were divided according to the presence of EDFF (group 1: EDFF+, group 2: EDFF-) and RV size (group A: small RV, group B: large RV [>150ml/m2]). RESULTS: Group 1 (n=23) had higher a right atrial pressure (RAP), pressure gradient between the RAP and pulmonary diastolic pressure (PDP), and atrial natriuretic peptide (ANP) levels than group 2. Four patients (17.4%) in group 1 and 89.7% of patients in group 2 had a normal RAP range (a wave<10mmHg). There were no differences in the RV volume, ejection fraction (EF), B-type natriuretic peptide levels, and severity of pulmonary regurgitation (PR) between groups 1 and 2. Group A had better RV and LVEF than group B, as well as a smaller LV size. The RAP in subgroup 1A was higher than that of the other 3 subgroups. Subgroup 1B had a similar RAP to group 2, and a lower PDP and a more severe PR than subgroup 1A. CONCLUSIONS:Patients with EDFF are associated with increased ANP levels. The presence of EDFF may not be specific for r-RVP, since it is observed in some TOFpatients with low PDP (severe PR) and normal RAP.
Authors: Jef Van den Eynde; Emilie Derdeyn; Art Schuermans; Pushpa Shivaram; Werner Budts; David A Danford; Shelby Kutty Journal: J Am Heart Assoc Date: 2022-03-18 Impact factor: 6.106