Open AccessEchocardiographic parameters of severe pulmonary regurgitation after surgical repair of tetralogy of Fallot
Author(s) -
Van Berendoncks An,
Van Grootel Roderick,
McGhie Jackie,
van Kranenburg Matthijs,
Menting Myrthe,
Cuypers Judith A.A.E.,
Bogers Ad J.J.C.,
Witsenburg Maarten,
RoosHesselink Jolien W.,
van den Bosch Annemien E.
Publication year - 2019
Publication title -
congenital heart disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.828
H-Index - 42
eISSN - 1747-0803
pISSN - 1747-079X
DOI - 10.1111/chd.12762
Subject(s) - medicine , tetralogy of fallot , cardiology , ventricular outflow tract , diastole , ventricle , regurgitant fraction , pulmonary artery , pulmonary valve , pulmonary valve insufficiency , regurgitation (circulation) , pulmonary regurgitation , ejection fraction , heart disease , blood pressure , heart failure
Abstract Aims Reliable evaluation of the severity and consequences of pulmonary regurgitation (PR) in patients with repaired tetralogy of Fallot (TOF) is crucial to timely identify the need for pulmonary valve intervention. We aimed to identify the accuracy of echocardiographic parameters to differentiate between moderate and severe PR, using phase contrast cardiac magnetic resonance imaging (CMR) as gold standard. Methods and results In this cross‐sectional study, 45 TOF patients with both echocardiographic and CMR measurements of PR were enrolled. All quantitative and semiquantitative echocardiographic measurements such as pressure half time (PHT), Color flow jet width (CFJW), ratio CFJW/right ventricle outflow tract (RVOT) diameter, PR index and the presence of early termination of the PR jet, end‐diastolic antegrade flow and diastolic backflow in main pulmonary artery (MPA), and PA branches correlated significantly with PR fraction on CMR. Qualitative assessment with color flow on echocardiography overestimated PR Multivariate linear regression analysis identified the ratio of CFJW/RVOT diameter and PHT as independent predictors of PR fraction. Accuracy of echo parameters was tested to differentiate between mild‐to‐moderate and severe PR Combining different echocardiographic parameters increased sensitivity and specificity. The addition of diastolic flow reversal in the PA branches to PHT below 167 milliseconds increased the NPV from 87% to 89% and PPV from 62% to 76%. Conclusions Comparison with CMR confirms that echocardiographic parameters are reliable in predicting PR severity. Combined measurement of diastolic flow reversal in the pulmonary artery branches and PHT is reliable in the detection of severe PR in the follow‐up of TOF patients.