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Background  To evaluate RV-PA coupling in post operative TOF patients with ventricular dilatation underwent for PVR and investigate the correlation between ventricular functions measuring Ea/Emax ratio using cardio magnetic resonance and the effect of surgical type at primary repair of TOF on coupling.    Method  RV-PA coupling was measured noninvasively by Ea/Emax ratio from CMRI and ECHO. From CMRI results the patients were divided in two groups, RV-PA coupling and RV-PA uncoupling. Ea/Emax ≤1 was considered for coupling patients and Ea/Emax > 1 for uncoupling patients.    Results  Ninety patients were uncoupled (Ea/Emax: 1.55 ± 0.46) and 45 were coupled (Ea/Emax: 0.81 ± 0.15). Out of 75 TAP repaired patients 60 were uncoupled RV-PV. In addition, higher pro-BNP is an important factor for uncoupled RV-PV ( P  = 0.001). CMR evaluation for right ventricular function between uncoupling and coupling were RVEDVi (196.65 ± 63.57 vs. 154.28 ± 50.07,  P  = 0.001), RVESVi (121.19 ± 51.47 vs. 83.94 ± 20.43,  P  = 0.001), RVSVi (67.19 ± 19.87 vs. 106.31 ± 33.44,  P  = 0.001), and RVEF (40.90 ± 8.73 vs. 54.63 ± 4.76,  P  = 0.001). The increased RVEDVi, RVESVi and RVSVi and decreased RVEF have significant correlation with Ea/Emax. Ea/Emax was also found positively correlated with RVEDVi ( P = <  0.05,  r  = 0.35), RVESVi ( P = <  0.001,  r  = 0.41) and negatively correlated with RVSVi ( P = <  0.05,  r  = 0.22) and RVEF ( P = <  0.05,  r  = 0.78).    Conclusions  Unfavorable RV-PA coupling is present in post operative TOF patients and it is affected by several factors. Our results explain a new concept of RV-PA interactions as a contributing mechanism for the observed decline in RV function.

journal of cardiothoracic surgery

Evaluation of right ventricle pulmonary artery coupling on right ventricular function in post operative tetralogy of Fallot patients underwent for pulmonary valve replacement