HEMODYNAMIC PARAMETERS AND RIGHT VENTRICULAR FUNCTION AFTER RADICAL CORRECTION OF FALLOT’S TETRAD

Abstract

Aim. The aim of the study was to estimate the early postoperative indices of hemodynamics in different types of the right ventricular output plasty after radical correction of Fallot’s tetrad and to assess the functional state of the right ventricle in the long-term postoperative period. Materials and methods. On the basis of SRICP named after Academician E.N. Meshalkin, a prospective cohort study of 52 patients (28 boys 24 girls), who underwent radical correction of Fallot’s tetrad, was conducted. Patients were divided into 2 groups by the type of reconstruction of the right ventricular outflow tracts: group I included patients with transannular plasty of the output part (group I, 26 patients), group II - patients with preserved fibrous ring of the pulmonary artery (group II, 26 patients). The postoperative hemodynamic status was assessed with transpulmonary thermodilution. The right ventricular function in the long-term period was estimated by means of US and MRI. Results. During the first postoperative hours, hemodynamic indices according to transpulmonary thermodilution technique were significantly lower in group I and reliably differed from group II. However, later (12, 24, 48 hour after), restoration of hemodynamic indices in group I, which did not significantly differ from group II, was observed. In the long-term period, ejection fraction of the right ventricle as a whole and of its separate parts was reliably higher in group II, while terminal diastolic volume of the right ventricle was significantly higher in group I. Pulmonary regurgitation was also significantly higher in group I - 36,7 (32; 44) versus 13,2 (3; 14) ( p < 0,01). Conclusions. Preservation of pulmonary artery fibrous ring provides better parameters of hemodynamics in the early postoperative period including systolic and diastolic functions. In the long-term period, this group of patients is less subjected to the right ventricular dysfunction.

Keywords

PiCCO / Fallot’s tetrad / PiCCO / MRI / pulmonary regurgitation / right ventricular dysfunction

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RIGHTS & PERMISSIONS

Omelchenko A.Y., Gorbatykh Y.N., Soinov I.A., Voitov A.V., Kulyabin Y.Y., Kornilov I.A., Chaschin O.V., Bogachev-Prokofiev A.V.