Real-time three-dimensional echocardiography in the assessment of pediatric perioperative right ventricular systolic function in tetralogy of Fallot and analysis of its influencing factors

Objective: To assess the perioperative right ventricular systolic function in pediatric patients with tetralogy of Fallot(TOF) who went through total correction surgery by real-time three dimensional echocardiography(RT3DE) and analyze the related factors with immediate postoperative right ventricular systolic function.Methods: To compare the right ventricular systolic functional parameters measured by RT3DE such as right ventricular end diastolic volume(RVEDV),end systolic volume(RVESV) and ejection fraction(RVEF) before and two or three days after surgical correction,and then using statistical analysis to explore the related clinical factors with post-RVEF.Results: Compared with the preoperative measurements,in two or three days after surgery,RVEDV and RVEF were significantly reduced,while RVESV was not changed significantly.Good correlation between the post-operative RVEF and four factors including adoption of trans-annular patch surgery,aortic cross-clamp time,residual shunting between two ventricles and residual obstruction of right ventricular outflow tract were found to be significant statistically.Adoption of the trans-annular patch surgery and aortic cross-clamp time were the more related factors with the post-operative RVEF.Conclusions: Right ventricular systolic function in children with TOF immediate after total correction surgery is reduced and mainly correlated with four operative factors.It is helpful to maintain the immediate post-operative right ventricular systolic function by shortening the aortic cross-clamp time,adopting the non-trans-annular patch surgery as well as completely correcting the anatomic deformities.