Change in Right Ventricular Strain After Cone Reconstruction of Ebstein’s Anomaly: A Cardiovascular Magnetic Resonance-Feature Tracking Study

Abstract

Background: Cardiovascular magnetic resonance Feature Tracking (CMR-FT) is a well-established method to assess myocardial contraction with diagnostic and prognostic value in many diseases. We aimed to evaluate the role of right ventricular (RV) CMR-FT in the perioperative assessment of Ebstein patients undergoing Cone repair. Methods: We analyzed the CMR data of 18 Ebstein patients before and after Cone repair including CMR-FT-derived global radial (GRS), global circumferential (GCS) and global longitudinal strain (GLS). Results: Following Cone repair, tricuspid regurgitation decreased from 48% to 6%, p = 0.0001. RV ejection fraction (51% to 33%, p = 0.0002), indexed RV stroke volumes (74 mL/m2 to 43 mL/m2, p = 0.0013) and GLS (−15.01% to −14.53%, p = 0.0155) decreased postoperatively. Conversely, GRS (15.00% to 17.83%, p = 0.0202) and GCS (−8.82% to −13.02%, p = 0.0026) improved. Indexed RV end-diastolic volumes (RVEDVis) decreased, although not significantly, from 161 mL/m2 to 122 mL/m2, p = 0.3465. Eight patients exhibited a higher RVEDVi after surgery. Pulmonary artery and aortic flow and left ventricular (LV) functional parameters remained unchanged. Conclusions: RV GLS appears to be affected by the hemodynamic alterations caused by Cone repair. RV GCS and GRS might serve as more independent parameters of myocardial function.

Keywords

• Ebstein’s anomaly
• cardiovascular magnetic resonance
• feature tracking
• cone repair