Factors associated with right ventricular dilatation and dysfunction in patients with chronic pulmonary regurgitation after repair of tetralogy of Fallot: Analysis of magnetic resonance imaging data from 218 patients

Objective: The aim of the present study was to identify the factors associated with right ventricular ( RV) dilatation and dysfunction in patients with chronic pulmonary regurgitation (PR) after repair of tetralogy of Fallot. Methods: From April 2002 to June 2013, 218 patients with repaired tetralogy of Fallot underwent magnetic resonance imaging; 165 (76%) underwent transannular repair and 36 (17%) underwent nontransannular repair. Linear regression analyses were used to identify the predictors for RV end-diastolic volume index (EDVI), end-systolic volume index (ESVI), and ejection fraction. Results: On univariable analysis, male sex, ventricular septal defect (VSD) closure through the right ventricle, larger pulmonary artery index, and greater PR fraction were associated with greater RV volume indexes. Multivariable analyses identified male sex (beta = 17.55, P < . 001 for RV EDVI; beta = 14.08, P = .001 for RV ESVI), VSD closure through RV (beta = 8.49, P = .048 for RV ESVI), longer interval since repair (beta = 1.29, P = .014 for RV EDVI), and greater PR fraction (beta = 1.92, P <. 001 for RV EDVI; beta = 1.38, P < . 001 for RV ESVI) as independent predictors for greater RV volume indexes. On univariable analysis, male sex, VSD closure through the right ventricle, and greater PR fraction were associated with a lower RV ejection fraction. Multivariable analysis identified male sex (beta = -3.10, P = .018), VSD closure through the right ventricle (beta = -3.05, P < .020), and greater PR fraction (beta = - 0.27, P < . 001) as independent predictors for a lower RVejection fraction. Conclusions: Male sex, VSD closure through the right ventricle, longer interval since repair, and greater PR fraction were independent predictors of RV dilatation after tetralogy of Fallot repair. Male sex, VSD closure through the right ventricle, and greater PR fraction were also independent predictors of RV dysfunction. (J Thorac Cardiovasc Surg 2014; 148: 2589-96)