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Right Ventricular Remodelling After Pulmonary Valve Replacement in Repaired Tetralogy of Fallot: Assessment With Cardiovascular Magnetic Resonance
Abstracts
S310
732 Repair of Partial Atrioventricular Septal Defect in Infants: A Multi-Institutional Review M. Daley 1,∗ , E. Buratto 1,2 , D. Radford 3 , N. Alphonso 4 , Y. d’Udekem 1,2 , C. Brizard 1,2 , I. Konstantinov 1,2 1 Cardiac Surgery Unit, The Royal Children’s Hospital, Melbourne, Australia 2 Department of Paediatrics, The University of Melbourne, Australia 3 The Prince Charles Hospital, Brisbane, Australia 4 Lady Cilento Children’s Hospital, Brisbane, Australia
Introduction: Partial atrioventricular septal defects (pAVSD) are usually repaired in the preschool years. However, due to significant left atrioventricular valve regurgitation (LAVVR) or congestive heart failure (CHF) repair may be performed in infancy. We performed a multiinstitutional review of outcomes of pAVSD repair in infants to determine long-term clinical outcomes in this group. Methods: From 1980 to 2014, 72 infants (<12 months of age) underwent pAVSD repair across 3 institutions. Data were obtained from hospital records and from general practitioners and cardiologists. Results: Mean age at pAVSD repair was 6.0 ± 3.5 months (median 5.2, range 0.6-11.9), 55.6% (40/72) had CHF and 36.1% (26/72) had moderate or greater LAVVR. Early mortality was 5.6% (4/72). Long-term survival was 84.9% (73.7-91.6%) at 10 years and 78.8% (60.5 – 89.3%) at 20 years follow-up. Cleft closure (HR=0.3, p = 0.04) and older age (HR=0.02, p=0.02) were associated with improved survival on univariate analysis. However, in multivariate analysis age remained a predictor of survival (HR=0.02, p=0.02), while cleft closure was not a significant predictor (HR=0.33, p=0.07). Reoperation was required in 29.2% of patients (21/72) of which, 22.2% (16/72) were LAVV procedures and 9.7% (7/72) were for left ventricular outflow tract obstruction. Permanent pacemakers were required in 6.9% (5/72) of patients. Conclusion: Repair of pAVSD carries a slightly higher risk when performed in infants. Given the higher rates of CHF and LAVVR in this group, early mortality is low and long-term survival is good. http://dx.doi.org/10.1016/j.hlc.2016.06.734 733 Right Ventricular Remodelling After Pulmonary Valve Replacement in Repaired Tetralogy of Fallot: Assessment With Cardiovascular Magnetic Resonance J. Hung ∗ , M. Stokes, R. Roberts-Thomson, S. Parvar, A. Nelson, K. Williams, M. Brown, P. Disney, K. Teo Royal Adelaide Hospital, Adelaide, Australia
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Introduction: Pulmonary valve replacement (PVR) in repaired Tetralogy of Fallot (ToF) is indicated for severe pulmonary regurgitation, in the presence of symptoms or decreased exercise tolerance. Previous studies have demonstrated marked reduction in right ventricular (RV) volumes, unchanged RV ejection fraction and some improvement in left ventricular parameters. We sought to assess RV remodelling after PVR using cardiovascular magnetic resonance (CMR). Method + Results: Eleven patients (6 male, mean age 36 ± 17 years) with repaired TOF and severe pulmonary regurgitation [regurgitant fraction 39% ± 10.9] and RV dilatation without significant pulmonary stenosis underwent CMR evaluation before (range 2-56 months) and after PVR (range 6- 34 months) Postoperative CMR demonstrated 29% reduction in RV end-diastolic volume from 143.6 ± 22.4 to 102.5 ± 26.4 mL/m2 (p < 0.0001), 34% reduction in RV end-systolic volume from 84.6 ± 21.1 to 55.6 ± 15.6 mL/m2 (p<0.0001), and RV ejection fraction increased from 41.73 ± 7.3% to 46.27 ± 6.0% (p 0.0005). LVEDV, LVESV and LVEF were not significantly improved (76 ± 15.4 to 80.9 ± 15.6, 31.2 ± 8.0 to 35.0 ± 8.0, 58.4 ± 3.8 to 57.0 ± 5.3, respectively). There was significant RV remodelling in all cases. There was an inter-observer variability range of -6.6 to 6.7%, mean difference 0.2 ± 3.3% for RVEDV, and -11.0 to 7.1 mean difference 1.9 ± 4.6 for RVESV. Conclusion: Significant positive RV remodelling is demonstrated with CMR after PVR in patients with repaired TOF. These findings are consistent with previously published studies. http://dx.doi.org/10.1016/j.hlc.2016.06.735 734 Tetralogy of Fallot: A 2D Phase Contrast MRI Analysis of Pulmonary Flow Dynamics K. Broadhouse 1 , F. Callaghan 1,∗ , M. Sudan 2 , G. Figtree 3 , R. Puranik 2 , D. Celermajer 2,4 , S. Grieve 1,4 1 Sydney
Translational Imaging Laboratory of Cardiology, Royal Prince Alfred Hospital, Camperdown, Australia 3 Department of Cardiology, Royal North Shore Hospital, Sydney, Australia 4 Sydney Medical School, University of Sydney, Camperdown, Australia 2 Department
Introduction: Advances in corrective surgery have improved survival rates following surgical repair of Tetralogy of Fallot (rTOF). However, progressive dysfunction, heart failure and mortality rates remain high [1]. Accurate assessment of pulmonary flow patterns represent a promising, sensitive index to measure and prognosticate right ventricular (RV) dysfunction and long-term management. We present detailed MRI analysis of rTOF flow patterns in the main pulmonary artery (MPA) to establish key abnormalities and correlation with degree of RV dilatation and dysfunction. Method: CMR data was acquired in 154 rTOF patients. MPA flow was measured using 2D PCMRI 1cm above the PV. Left ventricular (LV) and RV size and function were measured
S310
732 Repair of Partial Atrioventricular Septal Defect in Infants: A Multi-Institutional Review M. Daley 1,∗ , E. Buratto 1,2 , D. Radford 3 , N. Alphonso 4 , Y. d’Udekem 1,2 , C. Brizard 1,2 , I. Konstantinov 1,2 1 Cardiac Surgery Unit, The Royal Children’s Hospital, Melbourne, Australia 2 Department of Paediatrics, The University of Melbourne, Australia 3 The Prince Charles Hospital, Brisbane, Australia 4 Lady Cilento Children’s Hospital, Brisbane, Australia
Introduction: Partial atrioventricular septal defects (pAVSD) are usually repaired in the preschool years. However, due to significant left atrioventricular valve regurgitation (LAVVR) or congestive heart failure (CHF) repair may be performed in infancy. We performed a multiinstitutional review of outcomes of pAVSD repair in infants to determine long-term clinical outcomes in this group. Methods: From 1980 to 2014, 72 infants (<12 months of age) underwent pAVSD repair across 3 institutions. Data were obtained from hospital records and from general practitioners and cardiologists. Results: Mean age at pAVSD repair was 6.0 ± 3.5 months (median 5.2, range 0.6-11.9), 55.6% (40/72) had CHF and 36.1% (26/72) had moderate or greater LAVVR. Early mortality was 5.6% (4/72). Long-term survival was 84.9% (73.7-91.6%) at 10 years and 78.8% (60.5 – 89.3%) at 20 years follow-up. Cleft closure (HR=0.3, p = 0.04) and older age (HR=0.02, p=0.02) were associated with improved survival on univariate analysis. However, in multivariate analysis age remained a predictor of survival (HR=0.02, p=0.02), while cleft closure was not a significant predictor (HR=0.33, p=0.07). Reoperation was required in 29.2% of patients (21/72) of which, 22.2% (16/72) were LAVV procedures and 9.7% (7/72) were for left ventricular outflow tract obstruction. Permanent pacemakers were required in 6.9% (5/72) of patients. Conclusion: Repair of pAVSD carries a slightly higher risk when performed in infants. Given the higher rates of CHF and LAVVR in this group, early mortality is low and long-term survival is good. http://dx.doi.org/10.1016/j.hlc.2016.06.734 733 Right Ventricular Remodelling After Pulmonary Valve Replacement in Repaired Tetralogy of Fallot: Assessment With Cardiovascular Magnetic Resonance J. Hung ∗ , M. Stokes, R. Roberts-Thomson, S. Parvar, A. Nelson, K. Williams, M. Brown, P. Disney, K. Teo Royal Adelaide Hospital, Adelaide, Australia
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Introduction: Pulmonary valve replacement (PVR) in repaired Tetralogy of Fallot (ToF) is indicated for severe pulmonary regurgitation, in the presence of symptoms or decreased exercise tolerance. Previous studies have demonstrated marked reduction in right ventricular (RV) volumes, unchanged RV ejection fraction and some improvement in left ventricular parameters. We sought to assess RV remodelling after PVR using cardiovascular magnetic resonance (CMR). Method + Results: Eleven patients (6 male, mean age 36 ± 17 years) with repaired TOF and severe pulmonary regurgitation [regurgitant fraction 39% ± 10.9] and RV dilatation without significant pulmonary stenosis underwent CMR evaluation before (range 2-56 months) and after PVR (range 6- 34 months) Postoperative CMR demonstrated 29% reduction in RV end-diastolic volume from 143.6 ± 22.4 to 102.5 ± 26.4 mL/m2 (p < 0.0001), 34% reduction in RV end-systolic volume from 84.6 ± 21.1 to 55.6 ± 15.6 mL/m2 (p<0.0001), and RV ejection fraction increased from 41.73 ± 7.3% to 46.27 ± 6.0% (p 0.0005). LVEDV, LVESV and LVEF were not significantly improved (76 ± 15.4 to 80.9 ± 15.6, 31.2 ± 8.0 to 35.0 ± 8.0, 58.4 ± 3.8 to 57.0 ± 5.3, respectively). There was significant RV remodelling in all cases. There was an inter-observer variability range of -6.6 to 6.7%, mean difference 0.2 ± 3.3% for RVEDV, and -11.0 to 7.1 mean difference 1.9 ± 4.6 for RVESV. Conclusion: Significant positive RV remodelling is demonstrated with CMR after PVR in patients with repaired TOF. These findings are consistent with previously published studies. http://dx.doi.org/10.1016/j.hlc.2016.06.735 734 Tetralogy of Fallot: A 2D Phase Contrast MRI Analysis of Pulmonary Flow Dynamics K. Broadhouse 1 , F. Callaghan 1,∗ , M. Sudan 2 , G. Figtree 3 , R. Puranik 2 , D. Celermajer 2,4 , S. Grieve 1,4 1 Sydney
Translational Imaging Laboratory of Cardiology, Royal Prince Alfred Hospital, Camperdown, Australia 3 Department of Cardiology, Royal North Shore Hospital, Sydney, Australia 4 Sydney Medical School, University of Sydney, Camperdown, Australia 2 Department
Introduction: Advances in corrective surgery have improved survival rates following surgical repair of Tetralogy of Fallot (rTOF). However, progressive dysfunction, heart failure and mortality rates remain high [1]. Accurate assessment of pulmonary flow patterns represent a promising, sensitive index to measure and prognosticate right ventricular (RV) dysfunction and long-term management. We present detailed MRI analysis of rTOF flow patterns in the main pulmonary artery (MPA) to establish key abnormalities and correlation with degree of RV dilatation and dysfunction. Method: CMR data was acquired in 154 rTOF patients. MPA flow was measured using 2D PCMRI 1cm above the PV. Left ventricular (LV) and RV size and function were measured