Dynamics of echocardiographic parameters of right ventricular function in children after total correction of tetralogy of Fallot
Received: 2026-10-03
Published: 2026-03-30
Abstract
Background: Assessment of right ventricular (RV) function following total correction of tetralogy of Fallot is essential for the early detection of postoperative myocardial dysfunction and for guiding further follow-up strategies. However, the decline in traditional parameters of RV longitudinal systolic function in the early postoperative period may not only reflect true myocardial damage, but also alterations in cardiac geometry and mechanics resulting from sternotomy and pericardiotomy.
Objective: To evaluate the dynamics of echocardiographic parameters of right ventricular function in children after total correction of tetralogy of Fallot and to determine the impact of patient age and surgical correction type on their postoperative recovery pattern. Materials and Methods: A retrospective-prospective study was conducted involving 101 children with tetralogy of Fallot who underwent total surgical correction. Transthoracic echocardiography was performed preoperatively, on postoperative day 1, at 1 month, and at 3 months after surgery. TAPSE, z-TAPSE, peak systolic velocity of the lateral tricuspid annulus S’ and z-S’, right ventricular fractional area change (FAC), degree of pulmonary regurgitation, as well as left ventricular end-diastolic volume (EDV) and indexed end-diastolic volume (iEDV) were evaluated.
Results: On the first day after surgery, a marked decrease was recorded in TAPSE from 14.85 ± 1.76 to 6.80 ± 1.50 mm (p < 0.0001), S’ from 12.13 ± 1.23 to 6.20 ± 1.24 cm/s (p < 0.0001), and FAC from 44.45 ± 6.40 to 28.72 ± 6.15% (p < 0.0001). By month 3, TAPSE increased to 13.10 ± 1.86 mm, and S’ to 11.03 ± 1.14 cm/s. Patient age significantly influenced absolute TAPSE values across all follow-up stages (p < 0.0001); a positive correlation was established between age and the magnitude of TAPSE gain from day 1 to month 3 (r = 0.556; p < 0.0001). On day 1, the lowest TAPSE and S’ values were observed following transannular patch repair; differences between correction types were statistically significant (p = 0.006 and p = 0.007, respectively), but normalized by 1–3 months. LV iEDV consistently increased from 40.00 ± 15.05 to 59.40 ± 11.06 mL/m2 (p < 0.0001).
Conclusion: A pronounced drop in TAPSE and S’ immediately following total correction of tetralogy of Fallot is a regular early postoperative phenomenon, followed by substantial recovery over the first three months. Interpretation of right ventricular function should rely on a comprehensive assessment of TAPSE, S’, their z-scores, and FAC, mandatory considering child age and the type of surgical repair performed.
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