Identifying Risk Factors for Massive Right Ventricular Dilation in Patients With Repaired Tetralogy of Fallot
Section snippets
Methods
This was designed as a nested case-control study within a retrospective cohort. A center-specific CMR database was reviewed to identify patients with a diagnosis of TOF who underwent their first CMR imaging study at our center between the database's inception in October 2007 through March 2015. Inclusion criteria for the study were a diagnosis of TOF following complete surgical repair and first CMR performed postrepair at our center. Exclusion criteria included PVR before first CMR, unknown
Results
A total of 387 patients with TOF were identified during the study period. Of these, a total of 39 cases were identified and matched to 73 controls, for a total of 112 patients (71% male, median age at CMR 19.8 years, IQR 14.7 to 31.7 years). A flowchart depicting patient identification is shown in Figure 1. Patient, surgical, and clinical characteristics are depicted in Table 1. Additional cardiac lesions included a variety of defects including atrial septal defect, right aortic arch, and
Discussion
In patients with rTOF, age at complete repair >6 months, longer QRS duration, and non-Caucasian race were significantly associated with massive RV dilation at first CMR. An RV size by echo of moderately dilated or greater was sensitive, but not specific, to predict massive dilation on CMR. This population, 10% of the TOF patients referred to CMR at our center in this time period, is unlikely to have their RV return to normal size after PVR. To our knowledge, this is the first study reporting
Disclosures
The authors have no conflict of interest to disclose.
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Tetralogy of Fallot
2020, Cardiology ClinicsCitation Excerpt :It is important to recognize that much of the imaging data used in this decision focuses on identifying a pre-PVR threshold value of RV size that predicts normalization of RV volumes following PVR. Massive RV dilation is unlikely to resolve following PVR and is more likely to be seen in patients with late primary repair and nonwhite race.36 However, it has been shown that post-PVR RV size is not predictive of adverse clinical outcomes in rTOF patients, and new criteria need to be defined.37
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Clinton Cochran: Conceptualization, investigation, writing – original draft, writing – review and editing. Sunkyung Yu: Methodology, formal analysis, data curation, visualization, writing – review and editing. Lindsey Gakenheimer-Smith: Investigation. Ray Lowery: Data curation, formal analysis, software, investigation. Jimmy Lu: Visualization, writing – review and editing. Maryam Ghadimi Mahani: Visualization, writing – review and editing. Prachi P. Agarwal: Visualization, writing – review and editing. Adam Dorfman: Conceptualization, investigation, methodology, writing – review and editing, supervision, visualization.
Sources of funding: None.