Right Ventricular Dysfunction Clinical Trial
Official title:
Evaluation of Right Ventricular Contractility Reserve Function During Dobutamine Stress in Patients Following Surgical Repair of Tetralogy of Fallot
Background: Residual pulmonary regurgitation following repair of tetralogy of Fallot, in
particular the use of a transannular patch, has been shown to correlate with the development
of right ventricular dysfunction. Optimal timing of pulmonary valve replacement, therefore,
is important to preserve right ventricular function. Several recent studies suggested that a
threshold of right ventricular end-diastolic volume for intervention, in order to preserve
the likelihood of adequate reverse remodeling, is in the region of 150 to 200 ml/m2 body
surface area. However, there is evidence that right ventricular function does not always
recover following pulmonary valve replacement even if the end-diastolic volume is below this
cut-off.
In addition, previous studies suggested that early dysfunction may be present before
symptoms occur. However, early dysfunction is difficult to assess.
Methods: Analysis of right ventricular function by pressure-volume loops has been
extensively evaluated in experimental studies and is generally considered the optimal way to
quantify right ventricular function.
By recording a family of pressure-volume loops during reduction of preload, achieved by
temporary balloon occlusion of the inferior caval vein, the contractility can be calculated
by the slope of the endsystolic pressure-volume relation (elastance). Changes of
contractility following dobutamine infusion could be noted by changes of elastance. The
increase of the slope during dobutamine demonstrates the contractility reserve of the right
ventricle.
Purpose: To evaluate the right ventricular contractility reserve to determine early
ventricular dysfunction after repair of tetralogy of Fallot.
n/a
Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Diagnostic
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