Accuracy of a New Echocardiographic Index to Predict Need for Trans-annular Patch in Tetralogy of Fallot

Sowmya Kasturi, Seshadri Balaji, Abish Sudhakar, Gopalraj S. Sunil, Brijesh P. Kottayil, Praveen Reddy Bayya, Raman Krishna Kumar

Research output: Contribution to journalArticle

Abstract

The long-term outcome after repair of tetralogy of Fallot (TOF) is critically dependent pulmonary valve competence that is compromised by trans-annular patch (TAP). We compared a new echocardiographic index [pulmonary annulus index (PAI)] to conventional methods of predicting need for TAP in infants undergoing TOF repair. Consecutive infants undergoing TOF repair were prospectively studied. Pre-operative aortic and pulmonary annuli and main pulmonary artery (MPA) diameters were measured and z scores determined. PAI was a ratio of observed to expected pulmonary annulus (PA) diameter. TAP was based on intra-operative sizing by surgeons blinded to PAI values. Receiver operator curves (ROC) were generated for all PAI, MPA z scores and pulmonary annulus z scores. Of 84 infants (8.6 ± 2.6 months; 7.5 ± 1.3 kg), 36 needed TAP (43%). All the three indices viz. PAI, Pulmonary annulus and MPA z scores performed similarly in predicting need for TAP (ROC curves ~ 80%). Combining cut-offs of MPA z scores (> − 3.83) with either PAI (> 0.73) or PA z score (> − 1.83) predicted avoidance of TAP with ~ 90% accuracy. When both PAI and MPA z scores were below the cut-offs there was an 80% likelihood of TAP. Failure to predict TAP was associated with unicommisural pulmonary valves. PAI was equal to PA z scores in predicting need for TAP during repair of TOF. Combining either with MPA z scores was the most accurate method of prediction. Failure of prediction was mainly due to presence of a unicommissural pulmonary valve.

Original languageEnglish (US)
JournalPediatric Cardiology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Tetralogy of Fallot
Lung
Pulmonary Artery
Pulmonary Valve
Mental Competency

Keywords

  • Congenital heart disease
  • Echocardiography
  • Pulmonary valve
  • Tetralogy of Fallot

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

Cite this

Accuracy of a New Echocardiographic Index to Predict Need for Trans-annular Patch in Tetralogy of Fallot. / Kasturi, Sowmya; Balaji, Seshadri; Sudhakar, Abish; Sunil, Gopalraj S.; Kottayil, Brijesh P.; Bayya, Praveen Reddy; Kumar, Raman Krishna.

In: Pediatric Cardiology, 01.01.2018.

Research output: Contribution to journalArticle

Kasturi, Sowmya ; Balaji, Seshadri ; Sudhakar, Abish ; Sunil, Gopalraj S. ; Kottayil, Brijesh P. ; Bayya, Praveen Reddy ; Kumar, Raman Krishna. / Accuracy of a New Echocardiographic Index to Predict Need for Trans-annular Patch in Tetralogy of Fallot. In: Pediatric Cardiology. 2018.
@article{3700b8d24a9b44d88aa4cf2b218e9b3e,
title = "Accuracy of a New Echocardiographic Index to Predict Need for Trans-annular Patch in Tetralogy of Fallot",
abstract = "The long-term outcome after repair of tetralogy of Fallot (TOF) is critically dependent pulmonary valve competence that is compromised by trans-annular patch (TAP). We compared a new echocardiographic index [pulmonary annulus index (PAI)] to conventional methods of predicting need for TAP in infants undergoing TOF repair. Consecutive infants undergoing TOF repair were prospectively studied. Pre-operative aortic and pulmonary annuli and main pulmonary artery (MPA) diameters were measured and z scores determined. PAI was a ratio of observed to expected pulmonary annulus (PA) diameter. TAP was based on intra-operative sizing by surgeons blinded to PAI values. Receiver operator curves (ROC) were generated for all PAI, MPA z scores and pulmonary annulus z scores. Of 84 infants (8.6 ± 2.6 months; 7.5 ± 1.3 kg), 36 needed TAP (43{\%}). All the three indices viz. PAI, Pulmonary annulus and MPA z scores performed similarly in predicting need for TAP (ROC curves ~ 80{\%}). Combining cut-offs of MPA z scores (> − 3.83) with either PAI (> 0.73) or PA z score (> − 1.83) predicted avoidance of TAP with ~ 90{\%} accuracy. When both PAI and MPA z scores were below the cut-offs there was an 80{\%} likelihood of TAP. Failure to predict TAP was associated with unicommisural pulmonary valves. PAI was equal to PA z scores in predicting need for TAP during repair of TOF. Combining either with MPA z scores was the most accurate method of prediction. Failure of prediction was mainly due to presence of a unicommissural pulmonary valve.",
keywords = "Congenital heart disease, Echocardiography, Pulmonary valve, Tetralogy of Fallot",
author = "Sowmya Kasturi and Seshadri Balaji and Abish Sudhakar and Sunil, {Gopalraj S.} and Kottayil, {Brijesh P.} and Bayya, {Praveen Reddy} and Kumar, {Raman Krishna}",
year = "2018",
month = "1",
day = "1",
doi = "10.1007/s00246-018-1973-x",
language = "English (US)",
journal = "Pediatric Cardiology",
issn = "0172-0643",
publisher = "Springer New York",

}

TY - JOUR

T1 - Accuracy of a New Echocardiographic Index to Predict Need for Trans-annular Patch in Tetralogy of Fallot

AU - Kasturi, Sowmya

AU - Balaji, Seshadri

AU - Sudhakar, Abish

AU - Sunil, Gopalraj S.

AU - Kottayil, Brijesh P.

AU - Bayya, Praveen Reddy

AU - Kumar, Raman Krishna

PY - 2018/1/1

Y1 - 2018/1/1

N2 - The long-term outcome after repair of tetralogy of Fallot (TOF) is critically dependent pulmonary valve competence that is compromised by trans-annular patch (TAP). We compared a new echocardiographic index [pulmonary annulus index (PAI)] to conventional methods of predicting need for TAP in infants undergoing TOF repair. Consecutive infants undergoing TOF repair were prospectively studied. Pre-operative aortic and pulmonary annuli and main pulmonary artery (MPA) diameters were measured and z scores determined. PAI was a ratio of observed to expected pulmonary annulus (PA) diameter. TAP was based on intra-operative sizing by surgeons blinded to PAI values. Receiver operator curves (ROC) were generated for all PAI, MPA z scores and pulmonary annulus z scores. Of 84 infants (8.6 ± 2.6 months; 7.5 ± 1.3 kg), 36 needed TAP (43%). All the three indices viz. PAI, Pulmonary annulus and MPA z scores performed similarly in predicting need for TAP (ROC curves ~ 80%). Combining cut-offs of MPA z scores (> − 3.83) with either PAI (> 0.73) or PA z score (> − 1.83) predicted avoidance of TAP with ~ 90% accuracy. When both PAI and MPA z scores were below the cut-offs there was an 80% likelihood of TAP. Failure to predict TAP was associated with unicommisural pulmonary valves. PAI was equal to PA z scores in predicting need for TAP during repair of TOF. Combining either with MPA z scores was the most accurate method of prediction. Failure of prediction was mainly due to presence of a unicommissural pulmonary valve.

AB - The long-term outcome after repair of tetralogy of Fallot (TOF) is critically dependent pulmonary valve competence that is compromised by trans-annular patch (TAP). We compared a new echocardiographic index [pulmonary annulus index (PAI)] to conventional methods of predicting need for TAP in infants undergoing TOF repair. Consecutive infants undergoing TOF repair were prospectively studied. Pre-operative aortic and pulmonary annuli and main pulmonary artery (MPA) diameters were measured and z scores determined. PAI was a ratio of observed to expected pulmonary annulus (PA) diameter. TAP was based on intra-operative sizing by surgeons blinded to PAI values. Receiver operator curves (ROC) were generated for all PAI, MPA z scores and pulmonary annulus z scores. Of 84 infants (8.6 ± 2.6 months; 7.5 ± 1.3 kg), 36 needed TAP (43%). All the three indices viz. PAI, Pulmonary annulus and MPA z scores performed similarly in predicting need for TAP (ROC curves ~ 80%). Combining cut-offs of MPA z scores (> − 3.83) with either PAI (> 0.73) or PA z score (> − 1.83) predicted avoidance of TAP with ~ 90% accuracy. When both PAI and MPA z scores were below the cut-offs there was an 80% likelihood of TAP. Failure to predict TAP was associated with unicommisural pulmonary valves. PAI was equal to PA z scores in predicting need for TAP during repair of TOF. Combining either with MPA z scores was the most accurate method of prediction. Failure of prediction was mainly due to presence of a unicommissural pulmonary valve.

KW - Congenital heart disease

KW - Echocardiography

KW - Pulmonary valve

KW - Tetralogy of Fallot

UR - http://www.scopus.com/inward/record.url?scp=85052947943&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85052947943&partnerID=8YFLogxK

U2 - 10.1007/s00246-018-1973-x

DO - 10.1007/s00246-018-1973-x

M3 - Article

C2 - 30178189

AN - SCOPUS:85052947943

JO - Pediatric Cardiology

JF - Pediatric Cardiology

SN - 0172-0643

ER -