The Impact of Pulmonary Regurgitation on Right Ventricular Regional Myocardial Function: An Echocardiographic Study in Adults after Total Repair of Tetralogy of Fallot

Background: Early results of tetralogy of Fallot (TOF) surgical repair are excellent, but patients are at risk for long-term complications. The purpose of the study was to determine to what extent ultrasonic tissue indices can be helpful in assessing the degree of pulmonary regurgitation (PR). Methods: Fifty adults (26 men, 24 women; mean age, 34.4 years) who had undergone TOF correction were studied. Results: Compared with normal controls, patients had decreased tricuspid annular plane systolic excursion (20.66 vs 26.79 mm, P<.05). In patients with TOF, maximal strain was reduced in all right ventricular free wall and interventricular septal segments. In patients with previous palliative shunts, lower maximal strain for RV basal segment was observed compared with subjects with no palliative surgery (-18.22% vs -22.27%, P<.05). Maximal systolic and early diastolic strain and strain rate values were significantly higher in patients with PR widths >= 3 mm compared with patients with PR widths <3 mm. Conclusions: Adults after TOF repair have decreased regional deformation of the right ventricle and intraventricular septum. Prior palliative treatment reduces the indices of right ventricular regional deformation. PR severity can be described by the extent of right ventricular regional deformation. (J Am Soc Echocardiogr 2011; 24: 1199-204.)