Tetralogy of fallot in adulthood: Contribution of the right ventricle strain

Introduction

The course after complete cure of tetralogy of Fallot is fraught with complications including Right ventricle (RV) systolic dysfunction. MRI has long been considered the gold standard for the study of RV systolic function. However, it remains an expensive and not always available method. The new ultrasound techniques such as the strain of the RV can be of an important contribution.

Objective

Calculate global and segmental RV strain.

Compare the RV strain with conventional measurements of RV systolic function.

Study the factors favoring the alteration of the longitudinal strain of the RV.

Methods

This is a prospective study of 30 patients older than 18 years followed for operated tetralogy of fallot. We measured the fractional area change, the TAPSE, the S’ wave of the RV and the longitudinal strain of RV. We then compared the strain with the other measurements and looked for echographic abnormalities associated with altered longitudinal strain of the RV.

Results/Expected results

The measurement of the longitudinal strain of the RV in its free wall has a mean of –18. The strain measurement showed a significant gradient between the base of the RV and the apex with a basal mean of –20.7 and an apical mean of –15.6. This can be explained by a widening of the apex and a bulging of the base.

Alteration in longitudinal strain of the VD showed a significant correlation with FAC, whereas there was no correlation with TAPSE and S’ wave.

Right atrium dilatation, LV diastolic dysfunction, and residual pulmonary obstruction are the echocardiographic parameters associated with altered longitudinal strain of the LV.

Conclusion/Perspectives

In conclusion, the follow-up of patients operated on for tetralogy of Fallot is fraught with complications, including RV systolic dysfunction. The measurement of the longitudinal strain of the RV is a promising tool for the study of the RV.