[Left ventricular regional wall motion after correction of tetralogy of Fallot]

Cardiac function and left ventricular regional wall motion were examined using two-dimensional echocardiography in 40 post-operative patients of tetralogy of Fallot (TOF) of an average of 13 years after the correction. From the data of treadmill exercise test and cardiac catheterization, patients were classified into two groups; cases with complete ability for treadmill test (Group A, n = 22), and disabled for the test and the right ventricular systolic pressure above 50 mmHg (Group B, n = 18). Compared with the control group (n = 10), the patient groups had greater cardiothoracic ratios (CTR) and right/left ventricular dimensions (RVd/LVd) (p less than 0.001), and Group B had a greater CTR and RVd/LVd than Group A (respectively p less than 0.001). Compared with the control group, the patient groups had no significant differences in corrected ejection time, fractional shortening and mean velocity of circumferential fiber shortening, and no difference was noted between Group A and Group B. Left ventricular regional wall was divided into 12 segments around the left ventricular circumference on the two-dimensional short-axis view and the regional wall motion was evaluated on the basis of [(diastolic-systolic)/diastolic left hemiaxial length X 100%] values. In Group B, akinetic or dyskinetic wall motion was visualized at the interventricular septum and left ventricular posterior wall, but there was no abnormal motion in the control group and Group A. We concluded that even in postoperative patients with preserved cardiac function at rest, some of them had abnormal left ventricular regional wall motion due to the persistent right ventricular overload or corrective patch, resulting in low exercise capacity.