Journal of the American Society of Echocardiography
Clinical Investigations in ChildrenEchocardiography in Surgically Repaired Tetralogy of FallotEffects of Right Ventricular Hemodynamic Burden on Intraventricular Flow in Tetralogy of Fallot: An Echocardiographic Contrast Particle Imaging Velocimetry Study
Section snippets
Study Design
This was a single-center, prospective, clinical study. The institutional review board approved the study protocol. Inclusion criteria consisted of (1) repaired TOF, (2) age ≥ 13 years, (3) absence of any intracardiac shunt on previous imaging studies, and (4) sinus rhythm. Specific exclusion criteria were (1) greater than mild tricuspid valve regurgitation, (2) greater than mild pulmonary valve regurgitation, (3) contraindications to ultrasound contrast, and (4) lack of consent to participate
Results
The study population consisted of 41 subjects: 16 patients with TOF (10 men, six women) and 25 normal adult controls (15 men, 10 women). In the TOF group, 11 patients (69%) had primary repair, and five (31%) had previous shunt palliation before definite repair. Nine patients (57%) were repaired without transannular patches, five (31%) were repaired by the use of transannular patches, and the details of repair were unknown in two (12%). For the TOF group, planar maps suitable for
Discussion
Two-dimensional echocardiography remains the primary imaging modality for repaired CHD, with its excellent temporal and spatial resolution, portability, and low cost.15 Patients with repaired TOF undergo echocardiographic assessments as part of routine follow-up. There is limited experience with contrast echocardiography in children and adults with CHD; however, recent clinical trials have shown that ultrasonic contrast imaging is safe in this population.16
This is the first report of
Conclusions
Characterization of RV and LV flow parameters in patients with TOF is feasible using echocardiographic contrast PIV. It demonstrated that flow patterns in patients with TOF present abnormal properties with higher circulation and reduced energy dissipation that are potentially related to ventricular compliance changes. These insights into RV and LV functional properties in TOF merit further investigation, including evaluation of intraventricular PIV characteristics of the hypertrophic,
Acknowledgments
The authors are grateful to the patients who participated in this study. The authors thank Partho P. Sengupta, MD, for helpful suggestions on image acquisition. The authors also appreciate the assistance of the echocardiography laboratory staff at the University of Nebraska Medical Center.
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Cited by (14)
Multimodality Imaging of Right Heart Function: JACC Scientific Statement
2023, Journal of the American College of CardiologyVentricular Flow Profile in Young Patients With Single Left Ventricle Fontan Using Echocardiographic Contrast Particle Imaging Velocimetry
2023, Journal of the American Society of EchocardiographyContrast-Enhanced High-Frame-Rate Ultrasound Imaging of Flow Patterns in Cardiac Chambers and Deep Vessels
2020, Ultrasound in Medicine and BiologyCitation Excerpt :There are several review articles dealing with echoPIV using current clinically achievable frame rates of up to 100 frames/s (Sengupta et al. 2012; Rodriguez Muñoz et al. 2013; Pedrizzetti et al. 2014; Poelma 2017; Mele et al. 2019). There currently are two commercial echoPIV packages for analyzing the images of LV flow: the Omega Flow (Siemens, Mountain View, CA, USA) and HyperFlow software (Advanced Medical Imaging Development, Sulmona, Italy) (Abe et al. 2013; Goliasch et al. 2013; Agati et al. 2014; Kutty et al. 2014; Pedrizzetti et al. 2014; Mele et al. 2019). They have been validated in several studies (Kheradvar et al. 2010; Gao et al. 2012; Prinz et al. 2012).
Diagnostic and prognostic significance of cardiovascular vortex formation
2019, Journal of CardiologyCitation Excerpt :4D-Flow MRI provides additional information on blood flow profiles, e.g., vortex formation in the pulmonary artery [71,72]. The first systematic application of RV fluid dynamics in a clinical context was shown in patients with repaired TOF (r-TOF) using echo-PIV [73]. This study was performed in 4-chamber-view, which only shows a partial view of the complex 3D RV flow.
Intracardiac Flow Analysis: Techniques and Potential Clinical Applications
2019, Journal of the American Society of EchocardiographyCitation Excerpt :Stagnant flow in the periphery of the LA may predispose the atrial fibrillation patients to thrombus formation. Several authors studied vortical flow in the cardiac chambers of patients with pulmonary hypertension,65 single right ventricle and Fontan operation,66,67 and repaired tetralogy of Fallot.33 At present, however, it is not possible to draw conclusions on the application of vortex flow assessment in congenital heart diseases.
Right ventricular energetics and power in pulmonary regurgitation vs. stenosis using four dimensional phase contrast magnetic resonance
2018, International Journal of CardiologyCitation Excerpt :Large numbers of patients with congenital heart disease (CHD) of the right heart including pulmonary stenosis and tetralogy of fallot (TOF) are living with residual pulmonary stenosis and pulmonary regurgitation (PS and PR). In these patients, the right ventricle (RV) needs to cope with the burden of increased pressure and/or volume overload [1–4]. The RV in these clinical situations undergoes complex adaptation in response to the chronic load stresses, however traditional assessment of RV dimensions and function provide limited insights into this remodeling.
This study was funded by the Children's Hospital and Medical Center Foundation grant. Dr Kutty receives support from the American Heart Association.