Mariusz Kuśmierczyk

The Impact of Pulmonary Regurgitation on Right Ventricular Regional Myocardial Function: An Echocardiographic Study in Adults after Total Repair of Tetralogy of Fallot

BACKGROUND Early results of tetralogy of Fallot (TOF) surgical repair are excellent, but patients are at risk for long-term complications. The purpose of the study was to determine to what extent ultrasonic tissue indices can be helpful in assessing the degree of pulmonary regurgitation (PR). METHODS Fifty adults (26 men, 24 women; mean age, 34.4 years) who had undergone TOF correction were studied. RESULTS Compared with normal controls, patients had decreased tricuspid annular plane systolic excursion (20.66 vs 26.79 mm, P < .05). In patients with TOF, maximal strain was reduced in all right ventricular free wall and interventricular septal segments. In patients with previous palliative shunts, lower maximal strain for RV basal segment was observed compared with subjects with no palliative surgery (-18.22% vs -22.27%, P < .05). Maximal systolic and early diastolic strain and strain rate values were significantly higher in patients with PR widths ≥ 3 mm compared with patients with PR widths < 3 mm. CONCLUSIONS Adults after TOF repair have decreased regional deformation of the right ventricle and intraventricular septum. Prior palliative treatment reduces the indices of right ventricular regional deformation. PR severity can be described by the extent of right ventricular regional deformation.

Regional Left Ventricular Myocardial Shortening in Normotensive Patients Late after Aortic Coarctation Repair - Normal or Impaired?

Despite successful repair of aortic coarctation (AoC), changes in the left ventricular (LV) regional myocardial function are reported. The aims of this study were (i) to determine LV regional longitudinal deformation in patients who underwent a repair of AoC, who were normotensive and who had normal LV global function; and (ii) to establish a potential correlation between the degree of residual narrowing in the descending aorta and the extent of LV regional deformation. We studied 22 normotensive patients aged 19-58 y (mean 32.6; SD+/-11.3). Maximal strain, epsilon (%), as well as peak systolic and early and late diastolic strain rates (SRs; s(-1)), were obtained on the basis of speckle tracking. The data were compared with those obtained from sex and age-matched controls. Regional SRs were significantly reduced for the LV anterior wall during systole and early diastole -1.1 vs. -1.39; 1.41 vs. 1.86 s(-1), respectively; p<0.05. Transaortic maximal and mean gradients across the coarctation site correlated with epsilon and systolic SR obtained from the midsegment of the LV anterior wall. Despite a successful repair, absence of systemic hypertension and normal global LV function, regional deformation properties of the anterior LV wall were impaired. The degree of longitudinal impairment in this anatomical region correlated with the extent of residual narrowing.

Functional anatomy of tricuspid regurgitation in patients with systemic right ventricles.

OBJECTIVE Although the functional anatomy of mitral regurgitation has been thoroughly studied and is strongly predictive of postoperative outcome, the functional anatomy of tricuspid regurgitation (TR) in patients with systemic right ventricles has not been described. METHODS We measured the indices of tricuspid valve deformation, right ventricular remodeling and function, and brain natriuretic peptide (BNP) concentrations in a series of 42 patients (mean age 20.8 +/- 3.7 years) with systemic right ventricles after atrial switch for complete transposition of the great arteries. RESULTS TR was present in 34 patients. It was associated with predominant annular dilatation in 5 patients (14.7%), valvular prolapse in 14 patients (41.1%), and systolic leaflet tethering in 15 patients (44.1%). Compared with patients with valve prolapse, patients with leaflet tethering had greater end-systolic right ventricular cavity area (21.1 +/- 3.6 cm(2) vs 27.3 +/- 7.9 cm(2); P < .05), lower right ventricular fractional area change (0.40 +/- 0.09 vs 0.34 +/- 0.09, P < .05), and higher BNP levels (14.6 +/- 13.5 pg/mL vs 25 +/- 24.3 pg/mL, P < .05). Intermediate values were observed in patients with annular dilatation (23.9 +/- 5.6 cm(2); 0.37 +/- 0.05 pg/mL and 19.0 +/- 0.07 pg/mL, respectively). CONCLUSION Three distinct types of TR, caused by predominant annular dilatation, valve prolapse, and valve tethering, were apparent in patients with systemic right ventricles. They were associated with diverse severity of right ventricular dysfunction and BNP activation. Further studies are needed to assess the impact of variable functional anatomy of the systemic tricuspid valve on the outcome of medical and surgical therapies.

Repair of coarctation of the aorta with simultaneous coronary artery bypass grafting without cardiopulmonary bypass

The article describes the management of aortic coarctation associated with coronary artery disease by a one stage surgical procedure without cardiopulmonary bypass in a 44-year-old woman. The vascular prosthesis was anastomosed end-to-end to the descending aorta and a venous bypass was subsequently formed between circumflex coronary artery and the anastomosed vascular prosthesis. There were no postoperative complications.