Objective: The objective of this study was to evaluate cardiopulmonary stress echocardiograms (CPSE) and RV function (Tei index) in patients with Transannular Patch repair of Tetralogy (TOF/TAP). TOF/TAP creates obligate pulmonary insufficiency (PI) causing RV dilation and failure.

Methods: Retrospective study. 218 patients underwent TOF/TAP repair at Penn State Hershey Medical Center (2/74-7/08). 47 underwent pulmonary valve replacement (PVR) (29±18yr). Group A: pre-PVR, Group B: post-PVR, Group C: TOF/TAP/PI not yet needing PVR; n = 171.

Results: Exercise time was improved in Group B (12 Vs 9 in Group A) (p<.001); VO2max was not different. O2 pulse, ml/beat, was higher in Group B (12 vs. 9 in Group A, p<.001). RV augmentation during exercise (measured on a scale of 0 to -2, 0 normal, -2 severe dysfunction) was better in Group B (-0.9 vs. Group A -1.7, p<.0001); as was RV Tei index (0.2 versus Group A 0.4, p<0.0001).
The exercise duration of 161 patients in Group C was higher (11 min) than in Group A (9 min) (p< .0001). VO2max ((ml/kg/min) was 28 in Group C vs. 22 in A ( p=.007). RV augmentation (-.07 Vs -2.0 in Group A, p<.0001) and Tei index (0.2 versus 0.3,Group A, p< .0001) were both superior in Group C.

Conclusions: CPSE demonstrated that in patients with TOF/TAP/PI O2 pulse and both resting and exercise RV systolic function improves after PVR with preserved exercise capacity. CPSE offers a means to risk stratify TOF/TAP/PI for PVR and demonstrate physiologic benefits of surgery