Echocardiographie de la Tétralogie de Fallot opérée Diala Khraiche M3C-Necker Enfants malades, Université Paris Descartes Paris, France.
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
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
Repaired but not normal
Aim of the Echocardiography Evaluate Pulmonary regurgitation Evaluate Pulmonary obstruction Evaluate RV function Evaluate LV function Evaluate Aortic root dilation and aortic regurgitation
Chronic Pulmonary Regurgitation
How to quantify Pulmonary regurgitation 2D Echocardiography : only semiquantitative
Quantification fuite pulmonaire
Quantify the consequence of the regurgitation: RV dilation
IRM: gold standard pour les volumes VD
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
Detection of dilated RV by echo RVEDAi (cm/m²)
RV outflow tract stenosis Quantify: RV systolic pressure ( TV regurgitation velocity) Localize the site of the obstruction Evaluate RV systolic function and filling pressure
Pulmonary annulus obstruction
Stenosis of the pulmonary trunk
Stenosis of the two pulmonary branches
Stenosis of one Pulmonary Branch
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
Repaired ToF with chronic volume overload: risk of RV failure
RV function
Parameters of RV function that correlates best with MRI- RVEF JB Selly and al, Archives of Cardiovascular Disease (2015)
Echocardiographic predictors of mortality in adults with repaired TOF RV/RA LV Diller et al, circulation 2012
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)
LV function in TOF Myrthe E. Menting1 et al, European Heart Journal Cardiovascular Imaging (2015)
Altered LV function in repaired ToF Myrthe E. Menting1 et al, European Heart Journal Cardiovascular Imaging (2015)
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
La dissection aortique est rare
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
After pulmonary valve replacement Homograft Percutaneous valve: Melody, Carpentier Edwards Valve Function: regurgitation, obstruction. endocarditis