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44. Jahrestagung der Deutschen Gesellschaft für Pädiatrische Kardiologie
– Abstracts –
33
Chirurgie II und Grundlagenforschung
P35 – P41
Right ventricular-pulmonary arterial coupling is impaired
in patients after repair of tetralogy of Fallot
P34
H. Latus (1), W. Binder (2), G. Kerst (2), L. Sieverding (2),
M. Hofbeck (2), C. Apitz (1)
(1) Kinderherzzentrum Giessen; (2) Universitätskinderklinik Tübingen
Background: Histological alterations in the pulmonary trunk are described
in TOF-patients that might affect mechanical wall properties
which may contribute to right ventricular (RV) dysfunction and aggravate
pulmonary regurgitation (PR). Therefore, the purpose of our study was to
assess RV-pulmonary arterial (PA) coupling in TOF-patients with PR and
to evaluate the impact of the surgical technique used at primary repair.
Methods: PA elastance Ea (ratio of endsystolic pressure to indexed stroke
volume) and RV endsystolic elastance Ees were determined by pressurevolume
loops with conductance catheters at baseline level and during
dobutamine infusion (10 μg/kg/min). RV-PA coupling was calculated as
the ratio of Ea/Ees.
Results: 24 patients (mean age 16.7 ± 7.0 years) after TOF-repair were
enrolled in the study. Ees showed an appropriate increase under inotropic
stimulation from 0.24 ± 0.18 mmHg/ml/m2 to 0.47 ± 0.39 mmHg/ml/m2
(p 8 by the age of 7 years
(Aortic root 41 mm=54 mm/m 2 ) we performed prophylactic valve sparing
aortic root replacement (David procedure) with a 24 mm Vascutec
graft. Four months after the procedure, the patient presented with highly
elevated pro-BNP levels in severe heart failure with an EF