Right ventricular volume and function characteristics were evaluated in 25 pre-operative and 28 post-operative patients aged 10 days to 24 years. Pre-operative patients were grouped according to the pulmonary-to-systemic flow ratio (Qp/Qs) and post-operatively according to magnitude of right ventricular (RV) peak pressure (pr.) and residual pulmonary-to-RV pressure gradients (Δ PA-RV). Pre-operatively: cardiac index (CI) was highest and pulmonary index (PI) was lowest in those with smallest Qp/Qs; RV end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF)were all mildly depressed but not significantly different in various Qp/Qs groups. RV myocardial contractility index (MCI) approached normal for a systemic ventricle. Stroke work (SW) was lowest in patients with palliative left-to-right shunts (LRS). Post-operatively: EDV and ESV were elevated but highest in patients with high residual RV pr. or large Δ PA-RV. SV was normal. EF was depressed in all groups, being lowest in those with highest RV pr. or Δ PA-RV. SW and MCI were normal in low RV pr. RV outflow aneurysms were identified in 3/10 patients in the low RV pr. group and in 12/16 with highest residual pr. The incidence of pulmonary regurgitation (PR) was similar in each group. We conclude that post-operatively in patients with tetralogy of Fallot: (1) significant RV dysfunction persists being worst in those with high residual RV pr. and Δ PA-RV; (2) dysfunction is related to the incidence of RV outflow aneurysm and PR; and (3) elevated ESV results from large aneurysms with small diastolic to systolic volume change.
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Levin, A., Klein, A., Schiller, M. et al. 134 PRE-AND POST-OPERATIVE RIGHT VENTRICULAR VOLUME & FUNCTION CHARACTERISTICS IN TETRALOGY OF FALLOT. Pediatr Res 12, 386 (1978). https://doi.org/10.1203/00006450-197804001-00139