Abstract
Right ventricular dilation is a common complication after tetralogy of Fallot (TOF) repair. Traditional echocardiographic assessments are imprecise due to the RV’s location and complex geometry. We propose a novel echocardiographic measurement: RV apical flattening (RVAF) as a screening tool to help identify subjects with severe RV dilation. Patients with repaired TOF who had both echocardiograms and CMR’s within 6-month interval at our institution were included in the study. The RVAF was measured in the four-chamber echocardiographic view as the minor length of RV cavity at the level of RV apical endocardium. Subjects were divided into two groups (group I: RVEDVi ≥ 150 ml/m2 and group II; RVEDVi < 150 ml/m2). Echocardiogram and CMR data were compared between groups. A total of 75 subjects were included in the study. Mean age was 12.8 ± 3.6 years. Group I had 36 subjects, and group II had 39 subjects. The mean RVAF was significantly higher in group I (2.7 ± 0.5 cm) compared with group II (1.7 ± 0.4 cm; p < 0.001). There was significant correlation between RVAF and RVEDVi (r = 0.81; p < 0.001). By ROC analysis, an RVAF cutoff value of 2.0 cm had 94 % sensitivity and 77 % specificity in identifying severe RV dilation (area under the curve 0.95). RVAF is a simple and effective echocardiographic screening tool to help identify severe RV dilation. In conjunction with other 2D echocardiographic parameters, this technique would help further refine echocardiography-guided patient selection for timing of CMR and pulmonary valve replacement.
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Author Contributions
Sujatha Buddhe: Concept/design, Data analysis/interpretation, Drafting article; Approval of article, Mark Ferguson: Concept/design, Critical revision of article; Approval of article, Bhawna Arya: Data analysis/interpretation; Drafting article; Approval of article, Brian Soriano: Concept/design, Critical revision of article, Approval of article.
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Buddhe, S., Ferguson, M., Arya, B. et al. Right Ventricular Apical Flattening as an Echocardiographic Screening Tool for Right Ventricular Enlargement. Pediatr Cardiol 37, 568–574 (2016). https://doi.org/10.1007/s00246-015-1316-0
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DOI: https://doi.org/10.1007/s00246-015-1316-0