N Abdelrazik, A Abdelgawad, M Hamed
conventional echocardiography, doppler tissue imaging dti, tetralogy of fallot tof, ventricular function
N Abdelrazik, A Abdelgawad, M Hamed. Assessment of Ventricular Function in Tetralogy of Fallot Patients Using Tissue Doppler. The Internet Journal of Pediatrics and Neonatology. 2006 Volume 7 Number 2.
TOF: Tetralogy of Fallot
DTI: Doppler tissue imaging
RV: right ventricle
ME: early diastolic velocity at mitral valve
MA: late diastolic velocity
MS: peak systolic velocity
TE: early diastolic velocity at tricuspid valve
TA: late diastolic velocity
TS: peak systolic velocity
Echocardiographic findings of tetralogy of Fallot (TOF) are diagnostic in infants and young children, and echocardiography may be the only examination required prior to surgery. Conventional radiography, MRI, and angiography also are helpful for complete preoperative evaluation in some cases. Angiography has been used for preoperative evaluation of the coronary arteries and peripheral pulmonary circulation. However, intracardiac catheterization may stimulate pulmonary outflow tract spasm. Noninvasive peripheral pulmonary arterial evaluation is possible with MRI . Echocardiography proved to be effective in evaluation of left ventricular volumes in patients with Fallot's tetralogy .Right ventricular morphology in tetralogy of Fallot had a great impact in the surgical decision and outcome after total repair. Small ventricular size or impaired function will have a poor prognosis than normal ventricle size and function .Left ventricular morphology in tetralogy of Fallot may have a great brunt in surgical decision and outcome after total repair. Small left ventricular size or impaired function may have a poor prognosis than normal left ventricle size and function . Global left ventricular function determined by conventional Doppler may be normal in these patients; but regional myocardial function assessment by tissue Doppler if abnormal in these patients may affect outcome later on . The aim of this study is to evaluate ventricular functions in Fallot's tetralogy using conventional and tissue Doppler echocardiography.
Patients and Methods
The present study was conducted in the period from April, 2005 through April, 2006 at Cardiology Unit, Mansoura University Children's Hospital, Mansoura, Egypt.Thirty patients with TOF were enrolled in the study. They included 19 (63.3 %) males and 11 (36.7 %) females, age 37.8 ± 19.31 months. Twenty age-matched healthy subjects (36.3 ± 14.88 months( were included as a control group with approval of the study by the Institutional Ethics Committee and after informed consent was given by the parents.
Selection of patients
Tetralogy of Fallot with typical anatomy .
Patients associated with another congenital heart disease.
Fallot's tetralogy with atypical anatomy.
All patients were subjected to the following: Clinical assessment & evaluation. This included: Careful history taking, with special attention to symptoms of cyanotic heart disease, growth retardation and heart failure. Thorough general and cardiac examination with particular emphasis on signs of cyanotic heart disease, RVH, VSD, pulmonary hypertension and heart failure. ECG recording, X-ray,
The reported data were processed using SPSS ver. 10 under Microsoft Windows XP. Continuous data were expressed in the form of mean ± SD. Student t test was used to compare numerical data, while categorical data were compared using chi-square test. Pearson's correlation coefficient was used to correlate variables. P value < 0.05 was considered significant.
Thirty-patients with TOF, and 20 healthy age-matched controls were included in the present work. There was no significant difference as regard age (months), sex, and weight between patients and controls (P = 0.76, 0.9, 0.66 respectively). There was no significant difference between males (n = 19) and females (n = 11) regarding Doppler Tissues Imaging (DTI) parameters. Comparison of Doppler Tissues Imaging (DTI) parameters between TOF group (n = 30) and control (n = 20) showed significantly lower ME (10.77±3.73
Doppler Tissue Imaging (DTI) is an echocardiographic technique that measures myocardial velocities and has been demonstrated to be an indicator of global left ventricular (LV) function  and right ventricular (RV) function . The majority of noninvasive measures of systolic and diastolic ventricular performance are significantly impacted by changes in loading conditions. Traditional echocardiographic measures of systolic function including shortening fraction and ejection fraction and Doppler measures of left ventricular (LV) diastolic function, namely mitral and pulmonary venous inflow Doppler, are significantly affected by altered LV preload and afterload .
DTI has been reported to be a sensitive measure of longitudinal systolic and diastolic LV function that is relatively independent of changes in ventricular loading . Recent studies in children, however, have demonstrated that
DTI velocities are not only influenced by aging but also more significantly by changes in LV growth parameters, most notably LV end-diastolic dimension and LV mass . Compared with studies of the left ventricle, determining RV function has proved to be challenging using echocardiographic methods because of the unique, eccentric, and complicated morphology of the chamber . Reliable, rapid non-invasive evaluation of right ventricular function, especially in congenital heart disease lesions affecting primarily the right ventricle (RV) such as Tetralogy of Fallot (TOF), is desirable but presents many methodological issues. Standard two-dimensional echocardiographic evaluation of RV volumes and ejection fraction is inaccurate due to the difficulty in defining the RV endocardial surfaces as well as the complexity of its shape. Pulsed Doppler Tissue Imaging
(DTI) is a unique tool of measuring systolic and diastolic motion velocities of the tricuspid annulus with high spatial and temporal resolution, that appears to be associated with RV function  and RV performance during exercise .
DTI evaluation of the lateral tricuspid annular motion has been correlated with RV ejection fraction in adult patients with heart failure , while DTI velocities have been associated with RV performance in various congenital heart lesions affecting the RV, whether it supports the systemic  or the pulmonary circulation . In the current study, we aimed to evaluate the utility of
DTI in comparison with conventional Doppler in assessment of ventricular function in cases of TOF prior to surgical repair. Our study included 19 males (63.3 %) and 11 females (36.7 %) with mean age of 37.8 ± 19.31 months. This sex distribution of cases is in agreement with
Dr.Nabil Abdelrazik, M.D Associate professor of pediatrics Mansoura University Children's Hospital Mansoura Faculty of Medicine Mansoura EGYPT firstname.lastname@example.org