Research Presentation June 23, 2009 Nimish Muni Resident Internal Medicine
Research Question In adult patients with repaired Tetralogy of Fallot, how does Echocardiography compare to MRI in evaluating Pulmonary Insufficiency and Right Ventricular characteristics?
Tetralogy of Fallot 1. Pulmonic Stenosis 2. Ventricular Septal Defect 3. Overriding Aorta 4. Right Ventricular Hypertrophy
TOF Background 10% of all congenital heart disease 3.9 per 10,000 live births Clinical presentation is dependent on severity of RV obstruction. Profound cyanosis Childhood murmur Right heart failure
TOF Surgical Repair Palliative Blalock-Taussig-Thomas Shunt Subclavian to Pulmonary Artery Intracardiac Repair primary goal is to relieve RV obstruction RVOT Transannular Patch repair RVOT-> Pulmonary Artery Bypass Conduit
TOF Surgical Strategies A: Transannular Patch B: Pulmonary Valve Bypass Conduit
TOF - Prognosis With childhood repair, pts with TOF are now living into adulthood Long-term risk factors for death include: Right Ventricular Dilation Pulmonary Insufficiency
TOF - Prognosis Pulmonary Valve Replacement decreases risk of death in appropriate patients Serial evaluation is required to determine timing of surgical intervention Currently, this is primarily done by TTE
Echocardiography Pulmonary Valve Difficult to visualize/measure flows Degree of regurgitation is measured qualitatively Right Ventricle Complex 3D geometry Size and function are evaluated qualitatively
Cardiac MRI Allows for quantitative measurements of : Pulmonary Valve Regurgitant Fraction Right Ventricular Size Right Ventricular Ejection Fraction
Color Doppler TTE
Cardiac MRI
Research Question In patients with repaired Tetralogy of Fallot, how does Echocardiography compare to MRI in evaluating Pulmonary Insufficiency and Right Ventricular characteristics?
Methods Reviewed UW experience from 2004-2008 Identified 49 cases with TTE and cmri within 6 months of each other Excluded those with interval surgical intervention
MRI RF vs TTE PI Severity
MRI RVEF vs TTE RV Dysfunction
MRI RV Size vs TTE RV Dilation
Statistical Analysis 2 Statistical Methods Employed 1. ANOVA Assesses significance of the differences between groups 2. Spearman s Rho Assesses correlation with nonparametric variables
Results Pulmonary Insufficiency ANOVA F = 11.5 p < 0.001 Spearman s Rho Correlation = 0.71 p < 0.001
Results RV Function ANOVA F = 6.7 p = 0.003 Spearman s Rho Correlation = -0.45 p = 0.001
Results RV Size ANOVA F = 3.0 p = 0.04 Spearman s Rho Correlation = 0.36 p = 0.01
Conclusions Retrospective assessment of TTE interpretation at UW shows the ability to reliably characterize PI, RV function, and RV size when compared to cmri in adult patients with repaired TOF
Thank you: Karen Stout, MD Catherine Otto, MD Lee Mitsumori, MD Ruth Engelberg Sarah Walters, MD
Selected References Hoffman JI. Incidence of congenital heart disease: I. Postnatal incidence. Pediatr Cardiol 1995 May-Jun;16(3):103-13. Gatzoulis MA, et al. Right and left ventricular systolic function late after repair of tetralogy of Fallot. Am J Cardiol 2000 Dec 15;86(12):1352-7. Geva T, et al. Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging. J Am Coll Cardiol 2004 Mar 17;43(6):1068-74. Discigil B, et al. Late pulmonary valve replacement after repair of tetralogy of Fallot. J Thorac Cardiovasc Surg 2001 Feb;121(2):344-51. Therrien J, et al. Pulmonary valve replacement in adults late after repair of tetralogy of fallot: are we operating too late? J Am Coll Cardiol 2000 Nov 1;36(5):1670-5. Therrien J, et al. Impact of pulmonary valve replacement on arrhythmia propensity late after repair of tetralogy of Fallot. Circulation 2001 May 22;103(20):2489-94. Simpson IA; Sahn DJ. Adult congenital heart disease: use of transthoracic echocardiography versus magnetic resonance imaging scanning. Am J Card Imaging 1995 Jan;9(1):29-37. Grothoff M, et al. Evaluation of postoperative pulmonary regurgitation after surgical repair of tetralogy of Fallot: comparison between Doppler echocardiography and MR velocity mapping. Pediatr Radiol. 2008 Feb;38(2):186-91. Li, W, et al. Doppler-echocardiographic assessment of pulmonary regurgitation in adults with repair tetralogy of Fallot: comparison with cardiovascular magnetic resonance imaging. Am Heart J. 2004 Jan;147(1):165-72.