Does Left Ventricular Function Change...

Print this Page

Email this Page

Does Left Ventricular Function Change In Patients with Pulmonary Insufficiency After Repair Of Tetralogy Of Fallot?

Marcus S. Schamberger, MD and Roger A. Hurwitz, MD, FAAP. Dept. of Pediatrics, Indiana University, Indianapolis, IN.

Pediatrics 1998, 102(3)Suppl:682-683 and Pediatric Cardiology 2000,21(3):244-48

Background: Surgical repair of Tetralogy of Fallot (ToF) frequently results in pulmonary insufficiency (PI). We previously demonstrated a decrease in right ventricular ejection fraction (RVEF) on late follow-up in 21 patients with PI after ToF repair. The present study evaluates: 1) the course of left ventricular systolic function after repair of ToF in patients with PI, and 2) the impact of PI and changing RVEF on left ventricular systolic function.

Methods: 21 asymptomatic patients with at least moderate PI after repair of ToF were studied serially by radionuclide angiocardiography. Left ventricular ejection fraction (LVEF) was measured by the blood pool technique. Baseline study was obtained a mean of 1.2 years after corrective surgery. Follow-up study was performed a mean of 10.2 years after surgery. Comparisons were made between serial estimates of LVEF, and between early and late LVEF versus normal values. Correlation between changes in RVEF and LVEF was also analyzed.

Results: The mean LVEF at baseline was 0.68 " 0.10, which is not different from our laboratory?s normal value of 0.68 " 0.09. At the time of reevaluation, the mean LVEF had dropped significantly to 0.60 " 0.11 (p<0.02). Four patients (19 %) had an abnormally low LVEF of < 0.51, which is >2 SD below our laboratory normal. Considering a change of 0.05 between studies as reproducible, 3 patients showed an increase in LVEF, 5 patients had no change in LVEF, and 13 patients (62 %) demonstrated a decrease in LVEF. Decrease in LVEF did not correlate with the change in RVEF (r= -0.13). Nevertheless, 11 patients (52 %) had either abnormally low RVEF or LVEF and 19 patients (90 %) had a significant drop in RVEF, LVEF, or both.

Conclusion: In spite of normal early post operative LVEF, many patients with PI after ToF repair show a significant decrease in LVEF in long term follow-up. This decrease does not correlate with the amount of change in right ventricular function. Since many asymptomatic patients have abnormal or deteriorating ventricular function late after ToF repair, continued surveillance with analysis of ventricular function is warranted.

US News - America's Best Children's Hospitals 2008

Web Design: NetMediaOne