5
Pulmonary Annulus Index (PAI)
Actual Pulmonary Annulus Diameter (PADA)/ PAI = Expected Pulmonary Annulus Diameter (PADE) PADE = PADA + AAD/2 where, AAD = Aortic Annulus Diameter
6  Z Score (Established by Rowlatt, Rinoldi and Lev) OBSERVED VALUE – EXPECTED VALUE/STANDARD DEVIATION (S.D.) OF THE EXPECTED VALUE
7
Transannular patch enlargement (TAPE) of the pulmonary valve
PULMONARY VALVE ANNULUS (PVA) SIZE / AORTIC VALVE ANNULUS (AVA) SIZE TAPE = OR PVA / AVA GREAT ARTERY ANNULUS SIZE RATIO [GA RATIO]
Intraoperative - PRV: LV Ratio {Kirklin’s Index} < 0.7 = optimal > 0.8 = TAPE Intraoperative - PRV: LV Ratio {Kirklin’s Index} < 0.7 = optimal > 0.8 = TAPE Intraoperative - PRV: LV Ratio {Kirklin’s Index} < 0.7 = optimal > 0.8 = TAPE
Postoperative Postoperative Postoperative
8
Tricuspid Annular Plane Systolic Excursion (TAPSE)
TAPSE is another two-dimensional measure with which one can assess systolic right ventricular function. TAPSE in pediatric patients. Normal >12 mm. Mild RV dysfunction 10–12 mm. Moderate RV dysfunction 8–10 mm. Severe RV dysfunction <7 mm.
9
Fractional Area Change (FAC)
The fractional area change is a two-dimensional measure of right ventricular global systolic function. RV FAC (%) Reference range 32%–60% Mild abnormal 25%–31% Moderate abnormal 18%–24% Severe abnormal <17%
10
Pulmonary Regurgitation (PR) in Postoperative TOF for Determining Right Ventricular Contractile Dysfunction
PR is classified as: Mild (No retrograde diastolic flow in the pulmonary trunk with a detectable regurgitant jet in the RV outflow tract) Moderate (retrograde diastolic flow in the main pulmonary artery) Severe (additional retrograde diastolic flow in branch PAs).
11
Isovolumic Myocardial Acceleration (IVA)
Experimental and a clinical study as a new tissue Doppler-based index of systolic RV function post-TOF repair. - IVA demonstrates reduced contractile function in relation to the degree of PR and may be an early, sensitive index for selecting patients for valve replacement.
12
Pulmonary Regurgitation (PR) used to calculate pulmonary artery diastolic pressure (using the modified bernoulli equation) and mean pulmonary artery pressure
PADP = RVEDP + Δ Ppv Where, PADP = Pulmonary artery diastolic pressure RVEDP = Right ventricular diastolic pressure Δ Ppv = Equals the pressure gradient between the pulmonary artery and right ventricular outflow tract. Calculate the end-diastolic gradient between the pulmonary artery and right ventricular outflow tract from the velocity of the pulmonary regurgitation jet. Add, assumed RVDP = RAP, then the equation can be applied - PADP = RVEDP + Δ Ppv PAmean = (PASystolic + 2 PAdiastolic) / 3