Is the presence of end-diastolic forward flow specific for restrictive right ventricular physiology in repaired tetralogy of Fallot?

Background: End-diastolic forward flow (EDFF) is recognized as restrictive right ventricular physiology (r-RVP), but conflicting results have been reported about effects on the clinical outcome in repaired tetralogy of Fallot (r-TOF). Objectives: We hypothesized that the EDFF by Doppler was not specific for diagnosing r-RVP. Methods: Sixty-two consecutive patients aged 15.7 +/- 11.6 years who underwent cardiac catheterization were studied. Patients were divided according to the presence of EDFF (group 1: EDFF+, group 2: EDFF-) and RV size (group A: small RV, group B: large RV [> 150 ml/m(2)]). Results: Group 1 (n = 23) had higher a right atrial pressure (RAP), pressure gradient between the RAP and pulmonary diastolic pressure (PDP), and atrial natriuretic peptide (ANP) levels than group 2. Four patients (17.4%) in group 1 and 89.7% of patients in group 2 had a normal RAP range (a wave < 10 mm Hg). There were no differences in the RV volume, ejection fraction (EF), B-type natriuretic peptide levels, and severity of pulmonary regurgitation (PR) between groups 1 and 2. Group A had better RV and LVEF than group B, as well as a smaller LV size. The RAP in subgroup 1A was higher than that of the other 3 subgroups. Subgroup 1B had a similar RAP to group 2, and a lower PDP and a more severe PR than subgroup 1A. Conclusions: Patients with EDFF are associated with increased ANP levels. The presence of EDFF may not be specific for r-RVP, since it is observed in some TOF patients with low PDP (severe PR) and normal RAP. (C) 2017 Elsevier B.V. All rights reserved.