Analysis of right ventricle function with strain imaging before and after pulmonary valve replacement

Area of Science:

• Cardiology
• Medical Imaging
• Pediatric Cardiac Surgery

Background:

• Pulmonary valve insufficiency is a common complication following tetralogy of Fallot (ToF) surgical repair.
• Severe pulmonary valve insufficiency can lead to right ventricular dysfunction.
• Accurate assessment of right ventricular function is crucial for patient management.

Purpose of the Study:

• To compare the utility of cardiac magnetic resonance (CMR) and echocardiographic strain imaging in evaluating right ventricular function in ToF patients with pulmonary valve insufficiency.
• To assess changes in right ventricular parameters before and after pulmonary valve replacement.

Main Methods:

• Patients with severe pulmonary valve insufficiency post-ToF correction were included.
• Cardiac magnetic resonance (CMR) measured right ventricular volumes and ejection fraction (RVEF).
• Echocardiographic strain imaging assessed myocardial strain and strain rate pre- and post-pulmonary valve replacement.

Main Results:

• CMR showed increased right ventricle size and volume, with deteriorated function pre-replacement; RVEF did not significantly change post-replacement.
• Echocardiographic strain imaging successfully differentiated healthy from dysfunctional myocardium.
• Strain and strain rate values significantly improved 6 months after pulmonary valve replacement.

Conclusions:

• Echocardiographic strain imaging is a promising non-invasive method for assessing right ventricular function in ToF patients.
• Further studies with larger cohorts and longer follow-up are warranted to establish strain imaging's role.
• Strain imaging may become a valuable alternative to CMR for evaluating post-surgical pulmonary valve insufficiency in ToF.