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s $55 3. BNP levels are higher comparing to healthy individuals, but not correlate with this echocardiographic gradients of the disease severity. 451 Evaluation of right ventricular function in patients with post-operative pulmonary regurgitation by transesophageal echocardiography A. Vitarelli 1 , Y. Conde 2, E. Cimino 2 , S. Stellato 2 , V. Padella 2, D. Battaglia 2, E Caranci 2, M. Cortes Morichetti 3. 1Roma ' Italy; 2La Sapienza Universi~ Rome, Italy; 3European Hospital Georges Pompidou, Paris, France Background: We explored the accuracy of transesophageal strain Doppler echocardiography in detecting RV dysfunction in patients (pts) with postoperative tetralogy of Fallot (T/F) and hemodinamically significant pulmonary regurgitation (PR). Methods: Transesophageal echocardiography with TDI and strain capabilities was performed in 14 pts aged 13-45 years who had repair of T/E 12 ageand sexmatched subjects with no signs of heart disease were selected as normal controls (CTR). A thorough esophageal, low esophageal and transgastric scanning was performed. The ratio of PR jet width measured by color Doppler to the infundibulum diameter was used to quantify the severity of PR (ratio >50% = moderate to severe PR). Right ventricular ejection fraction (EF), fractional shortening (FS), and tricuspid flow filling parameters (E/A ratio, DT) were determined. Offline analysis of the myocardial velocity data sets was performed using dedicated software. Velocity and strain traces from right ventricular free wall at 3 levels (basal, mid cavity, and apical) were processed in the esophageal 4-chamber view. Systolic and diastolic TDI values (Sw, Ew, Aw), peak systolic strain and systolic and diastolic strain rate values were determined. Results: Three pts presented with severely dilated RV and decreased fractional area change for progressive pulmonary insufficiency due to an outflow patch and were excluded from analysis. 11 pts with dilated RV and normal fractional area change were analysed. Ew/Aw ratio was lower in pts than in CTR (p<0.005). Peak systolic strain and systolic and diastolic strain rate were also reduced in pts compared to CTR (p<0.001). E/A ratio and DT were not different among the two groups. No correlation was found between E/A ratio, DT, and severity of PR. A highly significant relationship was shown between early diastolic SR and degree of PR (r=-0.79, p<0.001). Conclusion: In adolescent and adult pts after repair of T/F, TEE is recommended to assess morphofunctional details especially when transthoracic images are limited by paucity of acoustic windows. In the presence of hemodinamically significant pulmonary regurgitation, strain Doppler echocardiography can detect RV systodiastolic impairment not shown by conventional echo-Doppler echocardiography 452 Left ventricular false tendons and innocent heart murmurs of childhood I. Germanakis 1 , R. Perakaki 2, F. Parthenakis 3, A. Patrianakos 3, RE. Vardas 3, M. Kalmanti 4. 1 University Hospital Heraklion, Crete, Dpt of Pediatrics, Pediatric Cardiology Unit, Heraklion, Greece; 2University of Crete, Dpt of Pediatrics, Pediatric Cardiology Unit, Heraklion, Greece; 3 University Hospital Cardiology, Heraklion, Crete, Greece; ~ University Hospital Dpt of Pediatrics, Heraklion, Crete, Greece Left ventricular false tendons are considered as insignificant findings during routine echocardiographic evaluation. Aim: To evaluate whether false tendons are implicated in the pathogenesis of innocent heart murmurs of childhood. Methods: 100 children (mean age 7.4 + 8.6 yrs, range 1-16 yrs) were consecutively enrolled from the outpatient population of the Pediatric Cardiology Unit. Excluded were patients with structural heart disease (including mitral valve prolapse), anemia and febrile disease. During a detailed echocardiographic evaluation the presence and location of left ventricular false tendons was documented. Blood flow through all valves and left ventricular outflow tract (LVOT) was measured and TDI measurements on septal mitral valve annulus were performed. Patients were divided into two groups according to the presence or absence of the typical vibratory murmur, by an experienced pediatric cardiologist. Results: 61 of the children had an innocent murmur. The prevalence of false tendons was 88% and 61% in patients with and without murmur respectively (p=O.004) and their presence was associated with a 4.70.R (95% CI 1.5-14) for murmur. The total number and location of false tendon were significant predictors of murmur, Left ventricular false tendons particularly if located in LVOT (20.8 OR for murmur, p<O.0001). Patients with murmur had also significantly higher blood flow velocities in LVOT (0.9 vs 0.83 m/s), pulmonary artery (0.98 vs O.89m/s) and a higher transmitral E wave (1.06 vs 0.98 m/s). Conclusions: The presence of false tendons, especially if multiple and located in the left ventricular outflow tract in association with increased blood flow velocities, might contribute to the pathogenesis of innocent heart murmurs of childhood. 453 Adults with total correction of tetralogy of Fallotcardiopulmonary exercise testing and plasma BNP levels O. Trojnarska 1 , A. Gwizdala 2, A. Szyszka 2, Z. Oko-Sarnowska 3. l lnst " of Cardiology, Poznan Medical Academy, First Department of Cardiology, Poznan, Poland; 2 University of Medical Sciences, Cardiology, Poznan, Poland; 3 University of Medical Sciences, Clinical Farmacology, Poznan, Poland Introduction: Despite good long term results after total correction of tetralogy of Fallot (ToF) those patients (P) reach lower exercise capacity in comparison to healthy subjects. Aim: Evaluation of exercise capacity with cardiopulmonary exercise test (CPET) and serum BNP levels in adults after correction of ToF and their relation with ventricular function assessed by echocardiography. Material and methods: We studied 63 P (31M), mean aged 27,7±7,1 yrs, operated at the mean age 7,4±5,1yrs, mean 20,7±5,7yrs ago. The controls: 28 intact subjects (13M), mean aged 28,7±5,1 yrs. On echo left and right ventricular end diastolic diameters (LV & RV), left ventricular ejection fraction (EF), E, A mitral wave, deceleration time (DCT), isovolumic relaxation time (IVRT), right ventricular end systolic pressure (RVSP), right ventricular outflow tract obstruction (RVOTO), pulmonary regurgitation (PI) were measured. The maximal CPET was performed (measurements of ventilatory parameters during rest and modified Bruce protocol): forced vital capacity (FVC), minute ventilation (VE), first second forced expiratory volume (FEV1), maximum and peak oxygen uptake (VO2 and peak VO2), carbon dioxide production (VCO2), VENCO2 slope were assessed.Plasma BNP levels were measured by immunoradiometric assay (Shinoria BNP kit). Results: The P reached the following parameters higher then controls: RV 40,4±6,6 vs. 29,6±3,1 mm (p=0,00001); RVOTO cm/s 227,4±63,4 vs. 110,2±10,5 cm/s (p=0,00001), VENCO2 36,6±6,5 vs. 29,7±4,7 (p=0,004). The P reached the following parameters lower then controls: VO2 24,9±5,7 vs. 36,6±7,6 ml/kg/min (p=0,00001), peak VO2 1,6±0,6 vs. 2,9±0,9 I/rain (p=O,00001), VE 60,1±19,5 vs. 114,4±36,2 I/min (p=O,00001), FVC 3,7±0,9 vs. 4,9±1,1 I (p=0,00001), BNP 34,9±26,8 vs. 11,5±6,5 pg/ml (p=0,00001). Negative correlations were found between BNP and: VO2 (p=0,03), peak VO2 (p=O,0002), VE (p=O,001), VT(p=0,007), and FVC (p=0,038). Positive correlations were found between BNP and VE/VCO2 (p=0,005) and RVOTO (p=O,01). Relations were shown between neither BNP and EF nor LV diastolic function parameters. In P with at least II ° IP VO2% of 58,6±11,9% was lower than in P without IP (69,7±12,2%, p=0,O005). BNP levels did not differ significantly between those groups. Conclusions: 1. Exercise capacity of adults after correction of ToF is reduced, particularly in P with IR 2. BNP levels are elevated in this group of P indicating close relation to exercise capacity parameters. 3. Higher BNP levels in those P appear to result from right ventricular volume