Predictors of right atrial dilatation and long-term function after right ventricular outflow tract surgical repair: Quantification of restrictive physiology matters

Right diastolic dysfunction; Right atrium function; Restrictive physiologyDisfunción diastólica derecha; Función de la aurícula derecha; Fisiología restrictivaDisfunció diastòlica dreta; Funció de l'aurícula dreta; Fisiologia restrictivaRight ventricular (RV) diastolic dysfunction in patients with a surgically-repaired RV outflow tract (RVOT) obstruction merits further studies. Right atrial (RA) dilation and function may be related to (RV) diastolic dysfunction in this setting. The end-diastolic forward flow (EDFF) in the pulmonary artery (PA) has been suggested as a non-invasive marker of poor RV compliance, however, there is controversy regarding its true significance; EDFF quantification may help elucidate this controversy. Objective to study predictors of RA enlargement and dysfunction in patients with a surgically-repaired RVOT obstruction and its relationship with quantitative EDFF. Methods In 81 consecutive patients (mean age: 37.5 (±7) years), transthoracic echocardiography (Echo) and cardiac magnetic resonance (CMR) were performed. Echo parameters: RA size (indexed RA area (iRAA)), RA function (RA global strain (RAGS)) and maximum EDFF velocity-time integral (VTI-EDFF) obtained during a whole respiratory cycle. CMR-indexed RA area (imRAA) was also obtained. Patients were divided into three groups according to iRAA, imRAA and RAGS; bivariate analysis was performed. A multivariate model was then applied using variables that were found to be statistically significant in the bivariate analysis. Results Upon multivariate analysis, higher VTI-EDFF values and the presence of significant tricuspid regurgitation proved to be independent factors associated with increased iRAA and imRAA and lower RAGS, whereas RV volumes, function and pulmonary regurgitant fraction were not. Conclusion VTI-EDFF linearly correlated with the degree of RA dilation and deformation; EDFF quantification as against qualitative assessment may be considered a non-invasive tool for diastolic RV dysfunction

Valvuloplastia aórtica pediátrica: estudio de variables con influencia en los resultados a largo plazo

Fundamentos y objetivo: En la edad pediátrica, la valvuloplastia aórtica es considerada como una opción para el tratamiento paliativo de la estenosis aórtica congénita. Se revisaron las valvuloplastias aórticas sobre válvula nativa realizadas consecutivamente en nuestro centro desde marzo de 1994 hasta junio de 2013, con el objetivo de identificar variables asociadas a necesidad de reintervención en el seguimiento. Métodos: Análisis de pacientes sometidos a valvuloplastia aórtica, en relación a sus características clínicas, ecocardiográficas y evolutivas, de una serie de 51 individuos, dividida en dos grupos –neonatal y pediátrico– según si la valvuloplastia se hubiere realizado antes o después del mes de vida. El tiempo mediano de seguimiento fue de 5,8 años (0,5-12,3) por paciente. Resultados: De los 51 pacientes, 20 presentaban alguna malformación cardiaca asociada. Tras el procedimiento la media de los gradientes pico-pico descendió de 60 ± 18 a 25 ± 13 mmHg. Evolutivamente, la valvuloplastia inicial fue suficiente en 24 (47%) enfermos, en 12 (23,5%) pacientes se requirió revalvuloplastia por reestenosis a un tiempo mediano de 0,61 años (0,3-3,2), y en 13 (25%) se indicó cirugía a un tiempo medio de 1,62 años (0,4-10,9); en dos casos (4%) se perdió el seguimiento. Las variables: grupo neonatal, patrón diastólico restrictivo, z-score del diámetro telediastólico ventricular izquierdo  60 mmHg, se asociaron a necesidad de cirugía (p < 0,05) en el seguimiento. No se encontraron factores asociados a revalvuloplastia. Conclusiones: La valvuloplastia aórtica pediátrica es una opción terapéutica paliativa eficaz. En este estudio las variables descritas anteriormente se asociaron a necesidad de cirugía

Predictors of right atrial dilatation and long-term function after right ventricular outflow tract surgical repair: Quantification of restrictive physiology matters

Right ventricular (RV) diastolic dysfunction in patients with a surgically-repaired RV outflow tract (RVOT) obstruction merits further studies. Right atrial (RA) dilation and function may be related to (RV) diastolic dysfunction in this setting. The end-diastolic forward flow (EDFF) in the pulmonary artery (PA) has been suggested as a non-invasive marker of poor RV compliance, however, there is controversy regarding its true significance; EDFF quantification may help elucidate this controversy. Objective: to study predictors of RA enlargement and dysfunction in patients with a surgically-repaired RVOT obstruction and its relationship with quantitative EDFF. Methods: In 81 consecutive patients (mean age: 37.5 (±7) years), transthoracic echocardiography (Echo) and cardiac magnetic resonance (CMR) were performed. Echo parameters: RA size (indexed RA area (iRAA)), RA function (RA global strain (RAGS)) and maximum EDFF velocity-time integral (VTI-EDFF) obtained during a whole respiratory cycle. CMR-indexed RA area (imRAA) was also obtained. Patients were divided into three groups according to iRAA, imRAA and RAGS; bivariate analysis was performed. A multivariate model was then applied using variables that were found to be statistically significant in the bivariate analysis. Results: Upon multivariate analysis, higher VTI-EDFF values and the presence of significant tricuspid regurgitation proved to be independent factors associated with increased iRAA and imRAA and lower RAGS, whereas RV volumes, function and pulmonary regurgitant fraction were not. Conclusion: VTI-EDFF linearly correlated with the degree of RA dilation and deformation; EDFF quantification as against qualitative assessment may be considered a non-invasive tool for diastolic RV dysfunction