Korean J Radiol.  2019 Jun;20(6):956-966. 10.3348/kjr.2018.0891.

Changes in Right Ventricular Volume, Volume Load, and Function Measured with Cardiac Computed Tomography over the Entire Time Course of Tetralogy of Fallot

• Goo HW

• KMID: 2447074
• DOI: http://doi.org/10.3348/kjr.2018.0891

Abstract

OBJECTIVE
To characterize the changes in right ventricular (RV) volume, volume load, and function measured with cardiac computed tomography (CT) over the entire time course of tetralogy of Fallot (TOF).
MATERIALS AND METHODS
In 374 patients with TOF, the ventricular volume, ventricular function, and RV volume load were measured with cardiac CT preoperatively (stage 1), after palliative operation (stage 2), after total surgical repair (stage 3), or after pulmonary valve replacement (PVR) (stage 4). The CT-measured variables were compared among the four stages. After total surgical repair, the postoperative duration (POD) and the CT-measured variables were correlated with each other. In addition, the demographic and CT-measured variables in the early postoperative groups were compared with those in the late postoperative and the preoperative group.
RESULTS
Significantly different CT-based measures were found between stages 1 and 3 (indexed RV end-diastolic volume [EDV], 63.6 ± 15.2 mL/m2 vs. 147.0 ± 38.5 mL/m2 and indexed stroke volume (SV) difference, 7.7 ± 10.3 mL/m2 vs. 32.2 ± 16.4 mL/m2; p < 0.001), and between stages 2 and 3 (indexed RV EDV, 72.4 ± 19.7 mL/m2 vs. 147.0 ± 38.5 mL/m2 and indexed SV difference, 5.7 ± 13.1 mL/m2 vs. 32.2 ± 16.4 mL/m2; p < 0.001). After PVR, the effect of RV volume load (i.e., indexed SV difference) was reduced from 32.2 mL/m2 to 1.7 mL/m2. Positive (0.2 to 0.8) or negative (−0.2 to −0.4) correlations were found among the CT-based measures except between the RV ejection fraction (EF) and the RV volume load parameters. With increasing POD, an early rapid increase was followed by a slow increase and a plateau in the indexed ventricular volumes and the RV volume load parameters. Compared with the preoperative data, larger ventricular volumes and lower EFs were observed in the early postoperative period.
CONCLUSION
Cardiac CT can be used to characterize RV volume, volume load, and function over the entire time course of TOF.

Keyword

Multidetector computed tomography; Ventricular function; Pulmonary valve insufficiency; Tetralogy of Fallot

MeSH Terms

Humans
Multidetector Computed Tomography
Postoperative Period
Pulmonary Valve
Pulmonary Valve Insufficiency
Stroke Volume
Tetralogy of Fallot*
Ventricular Function

Figure

• 

  Fig. 1 Correlations between RV volumes, RV volume load parameters, and RV/LV volume ratios.A. Scatter plot showing high positive linear correlation (r = 0.782) between SVDi and RV EDVi. B. Scatter plot showing high positive linear correlation (r = 0.645) between RV VLf and RV EDVi. C. Scatter plot showing high positive linear correlation (r = 0.691) between ED RV/LV volume ratio and RV ESVi. D. Scatter plot showing high positive linear correlation (r = 0.623) between ES RV/LV volume ratio and RV ESVi. ED = end-diastolic, EDVi = indexed end-diastolic volume, ES = end-systolic, ESVi = indexed end-systolic volume, LV = left ventricular, RV = right ventricular, SVDi = indexed stroke volume difference, VLf = volume load fraction

• 

  Fig. 2 Loess smoothed regression trends of RV volume load parameter and ventricular volumes with increasing POD.A, B. SVDi and RV VLf showed staged trend characterized by early rapid increase, middle plateau, and late decline depending on POD. C–F. Indexed RV and LV volumes equally demonstrated early increase followed by plateau depending on POD. POD = postoperative duration

• 

  Fig. 3 Linear regression trends of ventricular function with increasing POD.A. Scatter plot showing low negative linear correlation (r = −0.235) between RV EF and POD. B. Scatter plot showing low negative linear correlation (r = −0.229) between LV EF and POD. EF = ejection fraction

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