Long-term assessment of right ventricular function in children with repaired tetralogy of Fallot by using right ventricular longitudinal strain

doi:10.3877/cma.j.issn.1672-6448.2025.02.008

Abstract

Abstract:

Objective

To evaluate the long-term dynamic changes in right heart morphology and function in children with repaired tetralogy of Fallot （rTOF） by using echocardiography for exploring the application value of right ventricular longitudinal strain.

Methods

A total of 22 rTOF children who had undergone surgery at Beijing Children's Hospital from July 2023 to September 2024 were included in this study.The average age was 11.9±2.5 years， and the median follow-up time was 11 years.The diameters of heart chambers， pulmonary valve regurgitation， and parameters of right ventricular function including tricuspid annular plane systolic excursion （TAPSE）， fractional area change （FAC）， free wall longitudinal strain （FWLS）， septal longitudinal strain （SLS）， and global longitudinal strain （GLS） were obtained.The echocardiographic data of rTOF patients obtained 5 years ago were reviewed （the median follow-up time was 5 years）.The data comparison between the 11-year follow-up and 5-year follow-up was carried out.Healthy children of similar body surface area and the same gender were included as the control group.The right heart morphology and function parameters of rTOF patients and the control group at two follow-up time points were analyzed.

Results

Compared with the control group at the two follow-up time points， rTOF patients had enlarged right ventricles and increased pulmonary artery flow velocity.The parameters of TAPSE， FAC，and longitudinal strain （FWLS， SLS， and GLS） were all lower than those of the control groups （P＜0.05）.Among the 22 patients at the two follow-up time points， 50.0% （11/22， median follow-up time of 5 years）and 59.1% （13/22， median follow-up time of 11 years） had moderate to severe pulmonary regurgitation，respectively.Comparing the data of rTOF patients at the two follow-up time points （median follow-up time of 11 years vs median follow-up time of 5 years）， TAPSE ［（0.23±0.04） vs （0.25±0.05）］， FAC ［（27.46±5.75）%vs （28.03±6.61）%］， and FWLS ［（-19.00±4.23）% vs （-20.47±5.49）%］ did not show a progressive decline.In contrast， SLS ［（-17.79±3.46）% vs （-20.82±4.30）%， P＜0.05］ and GLS ［（-18.39±3.68）% vs（-20.65±4.61）%， P＜0.05］ showed a progressive decrease.

Conclusion

In the long-term follow-up of rTOF patients， echocardiography indicates right ventricular volume overload due to the persistent pulmonary valve regurgitation， and right heart function parameters are lower than those of healthy children.Certain right ventricular longitudinal strain parameters can be used to evaluate dynamic right ventricular function.

Key words: Echocardiography, Tetralogy of Fallot, Strain, Follow-up

Jingya Li, Li Xue, Shanshan Li, Yawen Deng, Yan Sun, Ning Ma. Long-term assessment of right ventricular function in children with repaired tetralogy of Fallot by using right ventricular longitudinal strain[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2025, 22(02): 146-152.

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Figures/Tables 7

References 13

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组别	例数	RVth（mm）	LVEDD（mm）	PVAD（mm）	AOD（mm）	PFVP（m/s）
研究组1	20	35.03±5.51	41.25±4.63	19.54±4.31	22.43±3.29	2.17±0.66
对照组1	20	32.84±4.43	41.91±3.38	22.06±3.47	20.25±2.26	0.87±0.14
t 值		-2.180	0.600	2.819	-2.719	-9.116
P 值		0.043	0.556	0.011	0.014	＜ 0.001

组别	例数	RVth（mm）	LVEDD（mm）	PVAD（mm）	AOD（mm）	PFVP（m/s）
研究组1	20	35.03±5.51	41.25±4.63	19.54±4.31	22.43±3.29	2.17±0.66
对照组1	20	32.84±4.43	41.91±3.38	22.06±3.47	20.25±2.26	0.87±0.14
t 值		-2.180	0.600	2.819	-2.719	-9.116
P 值		0.043	0.556	0.011	0.014	＜ 0.001

组别	例数	TAPSE（mm）	FAC（%）	FWLS（%）	SLS（%）	GLS（%）
研究组1	20	16.30±2.41	26.89±5.89	-19.21±4.23	-18.08±3.38	-18.65±3.62
对照组1	20	21.27±2.79	45.22±3.57	-26.40±3.07	-22.69±1.90	-24.54±2.40
t 值		6.234	10.638	-5.940	-5.448	-6.053
P 值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

组别	例数	TAPSE（mm）	FAC（%）	FWLS（%）	SLS（%）	GLS（%）
研究组1	20	16.30±2.41	26.89±5.89	-19.21±4.23	-18.08±3.38	-18.65±3.62
对照组1	20	21.27±2.79	45.22±3.57	-26.40±3.07	-22.69±1.90	-24.54±2.40
t 值		6.234	10.638	-5.940	-5.448	-6.053
P 值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

组别	例数	RVth（mm）	LVEDD（mm）	PVAD（mm）	AOD（mm）	PFVP（m/s）
研究组2	22	26.17±3.53	34.50±4.45	15.20±3.26	19.62±3.77	2.43±0.61
对照组2	22	23.20±6.18	35.97±4.87	16.31±3.07	15.83±2.05	0.91±0.02
t 值		2.528	-1.814	-1.872	6.836	11.597
P 值		0.020	0.084	0.075	＜0.001	＜0.001

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