Follow up of Post-repair Tetralogy of Fallot

Tetralogy of Fallot Clinical Trial

Official title:

Non-invasive Imaging and Exercise Tolerance Tests in Post-repair Tetralogy of Fallot - Intervention and Course in Patients Over 8 Years Old

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00266188
• Other study ID #: MP 4.1
• Secondary ID: 01G10210
• Status: Completed
• Phase: N/A
• First received: December 15, 2005
• Last updated: September 20, 2011
• Start date: January 2005
• Est. completion date: June 2008

Study information

• Verified date: September 2011
• Source: Competence Network for Congenital Heart Defects
• Contact: n/a
• Is FDA regulated: No
• Health authority: Germany: Ethics Commission
• Study type: Observational

Clinical Trial Summary

Tetralogy of Fallot is the most frequent complex congenital heart malformation. Over the past five decades, surgical repair has been performed with respectable results. However, relevant postoperative residues frequently remain. Pulmonary insufficiency, in particular, has been identified as a factor limiting the right ventricular function and, accordingly, the quality of life and life expectancy.

With increasing use of cardiac MRI for both measurement of ventricular function and imaging of pulmonary arteries, residual defects have been discovered that were not detectable by echocardiography. There is mounting evidence of right ventricular pressure and volume stress in Fallot patients after surgical correction. At present, it is impossible to detect right ventricular insufficiency at an early stage. Hence, it is to be assumed that right ventricular insufficiency is underdiagnosed and therapeutic action frequently is initiated beyond the point of no return of ventricular function.

The objective of this study is the systematic collection of cross-sectional and longitudinal data from extensive standardised examinations, including MRI, echocardiography, pulmonary function and ergometry tests, ECG and quality of life assessments, in a large number of patients with surgically corrected tetralogy of Fallot, and the setup of a database. The data obtained are supposed to provide information on the long-term outcome of surgical correction, to help establish criteria for necessity and time of re-intervention or re-operation, and to assess the effectiveness of re-interventions and re-operations.

Description:

In the repair of tetralogy of Fallot, pulmonary insufficiency used to be tacitly accepted as a result of extensive transannular patching (TAP) and considered unobjectionable. In fact, this is well tolerated during the first postoperative years, but today there is increasing evidence that the resulting chronic volume stress to the right ventricle is harmful on the long run, in particular if there are stenoses of the pulmonary artery in addition. Such stenoses, partly due to distortions after shunt surgery, together with pulmonary insufficiency, lead to a combined volume and pressure load of the right ventricle. The chronic volume stress results in a decrease in biventricular function and exercise tolerance, associated with increasing electrical instability with frequent, mostly ventricular, dysrhythmias. This constellation brings about a significantly increased risk of cardiac death.

Pulmonary valve replacement can improve haemodynamics, exercise tolerance and dysrhythmia. However, it is still unclear, which criteria best indicate the need for re-operation or other re-intervention, such as balloon dilatations of peripheral pulmonary stenoses, and what may be the best point in time.

Cardiac MRI has been established as non-invasive method to quantify right and left ventricular function without radiation exposure. Correlating quantitative functional data to clinical conditions may permit the evaluation of factors that influence the long-term course after surgical repair of Fallot's tetralogy.

The objective of this study is to establish a broad database of cross-sectional and longitudinal (after one year) findings from extensive standardised examinations, including MRI, echocardiography, pulmonary function and ergometry tests, ECG, quality of life assessments performed and cardiac catheterisation, if indicated, on a large number of subjects with surgically corrected tetralogy of Fallot. The data obtained are supposed to determine parameters indicating beginning irreversibility of decreased cardiac function, to provide information on the long-term outcome of surgical correction, to help establish criteria for necessity and time of re-intervention or re-operation, and to assess the effectiveness of re-interventions and re-operations.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 406
• Est. completion date: June 2008
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 8 Years and older

Eligibility

Inclusion Criteria:

• Written consent of the patient and/or the patient's legal representative

• Patients with tetralogy of Fallot (including pulmonary atresia with extreme form of VSD ) after corrective operation

• The corrective intervention has to date back to at least one year before study inclusion

• Ergospirometry and MRI examination can be carried out on an outpatient basis (i. e. patients are normally older than 8 years)

• Patients are not selected according to functional status, i. e. in terms of potentially necessary reintervention measures (e. g. cardiac catheter intervention, pulmonary valve replacement)

Exclusion Criteria:

• Lack of consent

• Tetralogy of Fallot or pulmonary atresia with VSD without corrective operation (or corrective operation that dates back to less than one year before)

• Pulmonary valve agenesia, DORV (if there is a distinct discontinuity between mitral valve and aortic valve)

• Associated severe heart defects (e. g. AV canal)

• Other clinically relevant diseases, such as malignant tumour or florid diseases (in the investigating physician's assessment)

• Patient is not able to perform ergospirometry (bicycle/treadmill) or contraindication exists

• Absolute MRI contraindication, e.g. cardiac pacemaker

• Pregnant and breast-feeding patients

• Lack of cardiac catheter findings (or MRI) before initial operation -

Study Design

Observational Model: Cohort, Time Perspective: Prospective

Related Conditions & MeSH terms

• Tetralogy of Fallot

Locations

Country	Name	City	State
Germany	Universitätsklinikum RWTH Aachen	Aachen	North Rhine-Westphalia
Germany	Herz-und Diabeteszentrum Nordrhein-Westfalen	Bad Oeynhausen	North Rhine-Westphalia
Germany	Deutsches Herzzentrum Berlin	Berlin
Germany	Universitätsklinikum Charité	Berlin
Germany	Herzzentrum Duisburg	Duisburg	North Rhine-Westphalia
Germany	Universitätsklinikum Essen	Essen	North Rhine-Westphalia
Germany	Herzzentrum Hamburg, UKE	Hamburg
Germany	Medizinische Hochschule Hannover	Hannover	Lower Saxony
Germany	Universitätsklinikum Schleswig-Holstein Campus Kiel	Kiel	North Rhine-Westphalia
Germany	Herzzentrum Leipzig	Leipzig	Saxony
Germany	Universitätsklinikum Muenster	Muenster	North Rhine-Westphalia
Germany	Deutsches Herzzentrum Muenchen	Munich	Bavaria
Germany	Deutsches Kinderherzzentrum	Sankt Augustin	North Rhine-Westphalia
Germany	Universitätsklinikum Tübingen	Tübingen	Baden-Wuerttemberg

Sponsors (2)

Lead Sponsor	Collaborator
Competence Network for Congenital Heart Defects	German Federal Ministry of Education and Research

Country where clinical trial is conducted

Germany, 

References & Publications (5)

Beerbaum P, Barth P, Kropf S, Sarikouch S, Kelter-Kloepping A, Franke D, Gutberlet M, Kuehne T. Cardiac function by MRI in congenital heart disease: impact of consensus training on interinstitutional variance. J Magn Reson Imaging. 2009 Nov;30(5):956-66. — View Citation

Bodhey NK, Beerbaum P, Sarikouch S, Kropf S, Lange P, Berger F, Anderson RH, Kuehne T. Functional analysis of the components of the right ventricle in the setting of tetralogy of Fallot. Circ Cardiovasc Imaging. 2008 Sep;1(2):141-7. doi: 10.1161/CIRCIMAGI — View Citation

Mueller M, Rentzsch A, Hoetzer K, Raedle-Hurst T, Boettler P, Stiller B, Lemmer J, Sarikouch S, Beerbaum P, Peters B, Vogt M, Vogel M, Abdul-Khaliq H. Assessment of interventricular and right-intraventricular dyssynchrony in patients with surgically repai — View Citation

Riesenkampff E, Mengelkamp L, Mueller M, Kropf S, Abdul-Khaliq H, Sarikouch S, Beerbaum P, Hetzer R, Steendijk P, Berger F, Kuehne T. Integrated analysis of atrioventricular interactions in tetralogy of Fallot. Am J Physiol Heart Circ Physiol. 2010 Aug;29 — View Citation

Sarikouch S, Koerperich H, Dubowy KO, Boethig D, Boettler P, Mir TS, Peters B, Kuehne T, Beerbaum P; German Competence Network for Congenital Heart Defects Investigators. Impact of gender and age on cardiovascular function late after repair of tetralogy o — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	- Assessment of the biventricular function via MRI, colour Doppler echocardiography, tissue Doppler and strain-rate imaging in correlation with objective exercise tolerance
Primary	(spiroergometry)
Primary	- Subjective quality of life
Primary	- Prevalence of cardiac dysrhythmias
Primary	- Mortality (above all in relapse interventions, such as interventional cardiac catheter or operation)
Primary	- Morbidity (i. e. severe unwanted effects [SUE], particularly in relapse interventions, such as interventional cardiac catheter or operation)