Author/Authors :
Ajami, Gholamhossein Neonatal Research Center - Shiraz University of Medical Sciences, Shiraz, IR Iran , Alvasabi, Fathi Neonatal Research Center - Shiraz University of Medical Sciences, Shiraz, IR Iran , Mehdizadegan, Nima Neonatal Research Center - Shiraz University of Medical Sciences, Shiraz, IR Iran , Edraki, Mohammadreza Neonatal Research Center - Shiraz University of Medical Sciences, Shiraz, IR Iran , Mohammadi, Hamid Neonatal Research Center - Shiraz University of Medical Sciences, Shiraz, IR Iran , Amirghofran, Ahmad Ali Department of Thoracic and Cardiovascular Surgery - Shiraz University of Medical Sciences, Shiraz, IR Iran , Ghasemzade, Bahram Department of Thoracic and Cardiovascular Surgery - Shiraz University of Medical Sciences, Shiraz, IR Iran , Keshavarz, Kambiz Social Determinants of Health Research Center - Yasuj University of Medical Sciences, Yasuj, IR Iran , Amoozgar, Hamid Neonatal Research Center - Shiraz University of Medical Sciences, Shiraz, IR Iran , Arabi, Hamid Neonatal Research Center - Shiraz University of Medical Sciences, Shiraz, IR Iran , Naghshzan, Amir Neonatal Research Center - Shiraz University of Medical Sciences, Shiraz, IR Iran , Borzoee, Mohammad Neonatal Research Center - Shiraz University of Medical Sciences, Shiraz, IR Iran , Peiravian, Farah Department of Pediatrics - Kazerun branch, Islamic Azad University, Kazerun, IR Iran
Abstract :
Background: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart
disease. Most studies have focused on Right Ventricular (RV) dysfunction, while the left
ventricle has received less attention in patients with TOF.
Objective: This study aimed to investigate the Left Ventricular (LV) function after
surgical Pulmonary Valve Replacement (sPVR) in patients with repaired TOF (rTOF) by
Speckle Tracking Echocardiography (STE).
Methods: This single-center, observational, cross-sectional study was conducted on
58 volunteers (age: 15 - 31 years) divided into three groups as follows: 22 PVR patients
(mean age: 18.96 ± 7 year), 16 patients with rTOF, and 20 healthy controls who were
matched regarding the PVR age range. 2D echocardiography (including Doppler and
M-Mode indices of the right and left ventricles) and Speckle Tracking Echocardiography
(STE) (Global Longitudinal Strains (GLS) and 18 segment analyses) were performed for
all patients. All analyses were done using the SPSS software and P < 0.05 was considered
to be statistically significant.
Results: 2D echocardiography showed normal LV Ejection Fraction (LVEF) in all
study groups (64% in sPVR, 60% in rTOF (P = 0.127), and 62.5% in the control group).
However, the mean GLS of the left ventricle significantly reduced in both sPVR (-17.5 ±
2.5%) and rTOF (-17.1 ± 4.7%) patients in comparison to the control group (-20.2 ± 0.7%)
(P = 0.003). Yet, no significant difference was observed between the rTOF and sPVR
groups regarding the GLS (P = 0.9).
Segmental analysis of the Longitudinal Strain (LS) indicated a significant decrease in the
sPVR and rTOF groups in basal anterior, basal septal, basal anterolateral, mid-anterior,
and anterolateral segments. Except for the lower LS in the apical-anteroseptal segment,
this level was mostly spared in both sPVR and rTOF patients.
Conclusion: LVEF was within the normal range among the sPVR patients, but the
pattern of impaired segmental LS and GLS did not change compared to the rTOF
group. In conclusion, sPVR might not have a significant effect on the improvement of
LV function assessed by STE in patients with rTOF. LV damage occurring during the
surgical correction of TOF might have a permanent deteriorating effect on LV function.
