Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Winkler, M.
Spiroergometry, Brain Natriuretic Peptide and Cardiac Magnetic Resonance Imaging in Adults with repaired Tetralogy of Fallot.
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2020. pp. 78
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Gamillscheg Andreas
- Grangl Gernot
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- Abstract:
- Background: After corrective surgery of the Tetralogy of Fallot (rTOF), the most prevalent cyanotic congenital heart disease (CDH), more than 90% patients can expect to reach adulthood. During adulthood, most rTOF patients have to face complications such as pulmonary regurgitation (PR), (re)stenosis of the right ventricular outflow tract (RVOT), right and/ or left ventricular (RV, LV) dysfunction, reduced exercise capacity, arrhythmia or sudden cardiac death that may require reintervention. Patients and Methods: In this retrospective study, 97 rTOF patients ≥18 years (f: 43% m: 57%), were assessed between 2004 – 2018 at regular intervals (clinical examination, ECG, NT-pro BNP, echocardiography, spiroergometry, cardiac MR) at the outpatient clinic for adults with CHD of the Division of Paediatric Cardiology, Medical University Graz. Results: During follow up 38/97 (39,2%) patients underwent 53 reinterventions at a mean of 24,2±7,7 years after primary repair. In 43/53 cases RVOT reconstruction and in 10/53 cases PM/ ICD implantation was performed. After reintervention, the RV end-diastolic and end-systolic volumes (RVEDVi 160±34 vs. 104±27 ml/m2; RVESVi 94±28 ml/m2 vs. 59±24 ml/m2, p<0,001), the severity of the PR (PR fraction 41±20 % vs. 8±10%, p<0,001) in cardiac MR, the echocardiographic RV diameter (48±12 mm vs. 41±7 mm, p=0,005) and the NT-pro BNP (206±186 pg/ml vs. 150±107 pg/ml, p=0,015) decreased, whereas the systolic RV function increased significantly (RV-EF 40±8% vs. 46±8%, p=0,015). Systolic LV function, QRS duration, NYHA class and parameters in spiroergometry showed no significant changes following reintervention. At the last follow-up (26,7±8 years after corrective surgery), 83/97 (85,6%) patients were in the NYHA class I, the mean RV and LV systolic functions (RV-EF 46±8%, LV-EF 58±8%) and the RV diameter (41±7%) were normally ranged, RV volumes (RVEDVi 110±29%, RVESVi 61±24%) and the NT-pro BNP value (143±93 pg/ml) mildly increased. There was no significant difference between the two groups except for the severity of the PR in cardiac MR, with better results in the reintervention group (PR fraction 8±10% vs. 23±17%, p=0,004). Conclusion: More than 26 years after corrective surgery, the clinical conditions of 97 rTOF patients were excellent. Nevertheless, reintervention was performed in 40% of the patients.