Clinical InvestigationValvular and Congenital Heart DiseaseExercise capacity and biventricular function in adult patients with repaired tetralogy of Fallot
Section snippets
Methods
This was a retrospective analysis of 99 patients with repaired tetralogy of Fallot seen at the Toronto Congenital Cardiac Centre for Adults, Toronto, Canada, between July 1, 2003, and July 1, 2005. All patients undergoing echocardiographic assessment and a level 1 cardiopulmonary testing on the same day of their routine annual clinic visit were included in the study. Patients with prosthetic mitral or aortic valves or with additional congenital heart lesions were excluded. Assessment of
Results
The mean age of the cohort was 34 ± 11 years (range 19-72 years). Thirty-one percent (31/99) of patients had reoperation with a homograft implantation, and the median duration of homograft implantation before the study was 12 years. Severe residual PR was present in 49% (48/99) of patients. Ninety-three percent (93/99) of patients were classified as New York Heart Association (NYHA) functional class I. Twenty-six percent of these patients had a Vo2max value <20 mL/kg per minute. Additional
Discussion
In this study we found that patients with repaired tetralogy of Fallot have diminished exercise capacity. The factors that have been associated with limited exercise capacity in earlier studies of repaired tetralogy of Fallot, including older age, age at tetralogy of Fallot repair, chonotropic incompetence, and abnormal lung function, were confirmed in our study. However, we were unable to show an association between the RV size or the degree of pulmonary regurgitation and diminished exercise
Conclusions
Many patients with repaired tetralogy of Fallot had diminished exercise capacity. Impairment in RV and LV function is associated with diminished exercise capacity. Furthermore, there is a linear relationship between the RV and LV function, suggesting that ventricular interactions are contributing to the limited exercise capacity in this group of patients. Clinicians therefore need to be attentive to the function of both the RV and the LV in this group of patients. Strategies aimed at preserving
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Cited by (24)
Echocardiographic surveillance in children after tetralogy of Fallot repair: Adherence to guidelines?
2020, International Journal of CardiologyCitation Excerpt :Long-term outcomes of patients after repair of tetralogy of Fallot (TOF) are impacted by residual anatomic and hemodynamic abnormalities such as pulmonary valve regurgitation or stenosis, right ventricular (RV) dilation and biventricular dysfunction [1,2]. There is an increased incidence of arrhythmias (∼43%), exercise intolerance (28% had severely decreased exercise capacity with <50% predicted peak oxygen consumption), heart failure (12% NYHA functional class ≥ III), and sudden cardiac death beginning in early adulthood, which are often attributed to these abnormalities [3–5]. Therefore, longitudinal clinical surveillance is crucial in this patient population.
Subaortic right ventricular characteristics and relationship to exercise capacity in congenitally corrected transposition of the great arteries
2012, Journal of the American Society of EchocardiographyCitation Excerpt :The stage 1 cardiopulmonary tests were performed on an ergometer cycle (Elema, Solna, Sweden). The protocol used at our center has been previously described.12 Briefly, heart rate, oxygen saturation (finger probe), and ventilation are measured continuously, and measurements are averaged over 30-sec intervals.
Right ventricular-left ventricular interaction in adults with Tetralogy of Fallot: A combined cardiac magnetic resonance and echocardiographic speckle tracking study
2012, International Journal of CardiologyCitation Excerpt :We speculate that this discrepancy is due to the contribution of circumferential right ventricular fibers – which could not be assessed as part of the current study – or due to the contribution of enlarged, hypokinetic outflow tract portions with preserved inflow RV function. Previous studies have demonstrated reduced LV ejection fraction and myocardial performance index in ToF patients [8,33]. Although Ghai and colleagues have shown a worse prognosis in ToF patients with moderately or severely reduced LV ejection fraction [16], the majority of contemporary ToF patients have preserved LV ejection fraction [8].
Longitudinal exercise capacity of patients with repaired tetralogy of Fallot
2011, American Journal of CardiologyCitation Excerpt :Several cross-sectional studies of patients with rTOF have reported that older patients tend to have more compromised exercise function than their younger peers. In a study of 99 adults with rTOF, Samman et al6 documented the %VO2 peak to be depressed at 66 ± 13% of predicted. They found that older age, age at rTOF, chronotropic incompetence, and abnormal lung function were associated with limited exercise capacity.
Pulmonary Homograft Monocusp Reconstruction of the Right Ventricular Outflow Tract: Outcomes to the Intermediate Term
2010, Annals of Thoracic SurgeryCitation Excerpt :This natural history was documented in early animal studies [17], and has been confirmed as patients have had closer follow-up with advanced imaging techniques such as cardiac magnetic resonance imaging. The clinical course of tetralogy patients with RV dilation secondary to nonvalved transannular patching has been well documented [18–24]. Complications ranging from exercise intolerance, growth retardation, arrhythmia, and sudden death have been noted.