Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Cardiology

Post-operative right ventricular (RV) progressive dilatation and dysfunction especially with the development of pulmonary regurge (PR) is increasingly recognized after repair of tetralogy of fallot (TOF). The fragmented QRS (fQRS) complex reflects conduction delay due to myocardial fibrosis is a proposed preliminary simple screening tool for such changes. The aim of this study was to evaluate the correlation of fQRS with the right ventricular indices obtained by cardiovascular magnetic resonance (CMR) in repaired TOF patients. Thirty patients with repaired TOF were included. All patients had con-temporary ECG and CMR. The fQRS complex was defined as the presence of >2 R waves or >2 notches in the R/S wave in case of wide QRS complex and the presence of an additional R wave or notched S wave in two contiguous leads in case of narrow QRS complex. The mean age was 15±3.13 years, time passed since repair 11.5±1.87 years; fQRS was present in 70% of pts. fQRS was correlated to higher RV end-diastolic volume index (RVEDVI) (p<0.001), RV end-systolic volume index (RVESVi) (p<0.001), higher PR fraction (p =0.004), and lower RV ejection fraction (RVEF) (p=.018). A cutoff point of fQRS in 5 leads showed a sensitivity of 87.5% and specificity of 85.7% for detection of RVEDVI > 150 ml/m2, and 83.3% sensitivity, 66.7% specificity in identifying patients with PR fraction more than 45 %. Prolonged QRS duration was correlated to higher (RVEDVI) (p=0.004), (RVESVI) (p=0.006], with a trend towards lower RVEF p value =.145 and higher PR fraction p=.175

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