Echocardiographie de la Tétralogie de Fallot opérée

Transcription

1 Echocardiographie de la Tétralogie de Fallot opérée Diala Khraiche M3C-Necker Enfants malades, Université Paris Descartes Paris, France.

2 Disclosure Statement of Financial Interest I currently have, or have had over the last two years, an affiliation or financial interests or interests of any order with a company or I receive compensation or fees or research grants with a commercial company : Speaker's name: KHRAICHE Diala I do not have any potential conflict of interest

3 Unnatural History of ToF:Prospective Follow-Up of 40 Years After Correction Survie à 40 ans de 86% 12 décès : 10 ICC, 2FV 44% de réintervention 17% d arythmie 40% ont capacité fonctionnelle<85% de la théorique 24% dilatation aorte>40mm mais sans évolutivité Cuypers et al, Circulation 2014

4 Repaired but not normal

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8 Aim of the Echocardiography Evaluate Pulmonary regurgitation Evaluate Pulmonary obstruction Evaluate RV function Evaluate LV function Evaluate Aortic root dilation and aortic regurgitation

9 Chronic Pulmonary Regurgitation

10 How to quantify Pulmonary regurgitation 2D Echocardiography : only semiquantitative

11 Quantification fuite pulmonaire

12 Quantify the consequence of the regurgitation: RV dilation

13 IRM: gold standard pour les volumes VD

14 volumes et fonction VD: RT3DE Good correlation with MRI but systematic underestimation of the volumes Iriart X et al. Eur J Echocardiogr 2009 Shimada, JASE, 2010

15 Detection of dilated RV by echo RVEDAi (cm/m²)

16 RV outflow tract stenosis Quantify: RV systolic pressure ( TV regurgitation velocity) Localize the site of the obstruction Evaluate RV systolic function and filling pressure

17 Pulmonary annulus obstruction

18 Stenosis of the pulmonary trunk

19 Stenosis of the two pulmonary branches

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21 Stenosis of one Pulmonary Branch

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23 RV/PA obstruction RV pressure ( Tricuspid valve regurgitation) : significant obstruction when >60mmHg Systolic septal curvature ( if there is notr) Visualize the origin of two pulmonary arteries: - Size, Doppler acceleration

24 Repaired ToF with chronic volume overload: risk of RV failure

25 RV function

26 Parameters of RV function that correlates best with MRI- RVEF JB Selly and al, Archives of Cardiovascular Disease (2015)

27 Echocardiographic predictors of mortality in adults with repaired TOF RV/RA LV Diller et al, circulation 2012

28 Left ventricle dysfunction in repaired ToF - Altered septal curvature in diastole+/- systole - RV/LV interaction RV overload impedes LV function ( decreased LV stroke volume and EF)

29 LV function in TOF Myrthe E. Menting1 et al, European Heart Journal Cardiovascular Imaging (2015)

30 Altered LV function in repaired ToF Myrthe E. Menting1 et al, European Heart Journal Cardiovascular Imaging (2015)

31 Left ventricular function predicts mortality LVEF Simpson Biplan vs IRM Biais LOA ICC pvalicc -3,06 (5%) -15,56-9,43 (43%) 0,153 0, 843 LV EF by Simpson Method LV longitudinal strain Diller et al, circulation 2012

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34 La dissection aortique est rare

35 Conclusion : echo parameters needed in ToF follow up Pulmonary outflow tract: evaluate regurgitation and obstruction, Right ventricular systolic pressure Right Ventricle: RVEDAi, RV FAC, idexed RA area Left Ventricle : LV strain, LVEF, LV diastolic function Aorta : Aortic root dimensions, Quantify Aortic valve regurgitation

36 After pulmonary valve replacement Homograft Percutaneous valve: Melody, Carpentier Edwards Valve Function: regurgitation, obstruction. endocarditis

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