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Echocardiographic study of right and left ventricular dimension and left ventricular function in patients with
Insights
Tetralogy of Fallot patients often have underdeveloped left ventricles that grow to normal size after corrective surgery. Postoperative left ventricular function remains normal, and right ventricular size decreases significantly.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Tetralogy of Fallot is a congenital heart defect characterized by underdeveloped ventricles.
- Preoperative assessment of ventricular dimensions and function is crucial for surgical planning and outcomes.
Purpose of the Study:
- To evaluate right and left ventricular dimensions and function in children with Tetralogy of Fallot before and after corrective surgery.
- To assess the impact of corrective surgery on ventricular adaptation and function.
Main Methods:
- One-dimensional echocardiography was used to measure ventricular dimensions and function.
- 35 children with Tetralogy of Fallot underwent pre- and post-operative echocardiographic assessments.
- Follow-up echocardiography was performed 2-4 and/or 8 weeks after total correction.
Main Results:
- Preoperatively, left ventricular dimensions were smaller than expected (85.4% of normal), with 21 values below the 5th percentile.
- Postoperatively, left ventricular dimensions significantly increased, reaching normal values (103.2% of normal) within 4 weeks.
- Right ventricular dimensions decreased significantly postoperatively, and septal motion normalized in 50% of patients by 2 months.
Conclusions:
- Patients with Tetralogy of Fallot frequently present with underdeveloped left ventricles that exhibit normal function.
- Corrective surgery leads to significant improvement in left ventricular dimensions, with good adaptation to the postoperative state.
- Early normalization of septal movement may be associated with significant pulmonary stenosis.
Abstract:
Right and left ventricular dimensions and function were determined by one-dimensional echocardiography in patients with tetralogy of Fallot before and after corrective surgery. Thirty-five children (mean age: 5.9 years) were examined; 5 of them died immediately after operation; 5 had palliative operations only. The remaining 25 had repeat echocardiography 2 to 4 and/or 8 weeks after total correction. Compared with normal values, preoperative left ventricular dimensions were smaller than expected for body surface area (mean = 85.4% +/- 1.9 SEM, range 65 to 105% of normal); 21 values were below the 5th centile. Postoperatively, left ventricular dimensions increased significantly and reached normal values in most cases (mean = 103.2 +/- 2.0% SEM, range 81 to 121%). The main increase took place in the first 4 weeks (P less than 0.001; mean difference 0.7 +/- 0.14 cm). The 5 children who died after operation had smaller left ventricular dimensions than the survivors (P less than 0.01). Left ventricular function was evaluated by measuring mean circumferential fibre shortening, per cent shortening, and ejection fraction; they were normal in most patients and diminished only insignificantly after corrective surgery. Right ventricular dimensions were increased preoperatively but decreased significantly (P less than 0.001) postoperatively. Septal movement was normal in direction and excessive in displacement in most patients before operation; immediately after operation it became flat or showed paradoxical motion. Two months after operation 50 per cent of the children showed a return to normal septal movement. Early appearance of normal septal movement could be related to the presence of significant pulmonary stenosis. It is concluded that a high percentage of patients with tetralogy of Fallot have underdeveloped but normally functioning left ventricles which adapt well to the new postoperative state.