Right ventricular (RV) ejection fraction (EF) <45% is insensitive for detecting systolic dysfunction due to pulmonary regurgitation after Tetralogy of Fallot repair (rTOF). In pediatric rTOF patients with RVEF≥45% and healthy controls, CMR feature tracking was used to assess RV systolic strains and displacement as well as systolic and diastolic myocardial velocities. We observed abnormal RV global longitudinal strain and myocardial velocities in rTOF despite normal RVEF. 78% and 75% of rTOF patients had tricuspid annular displacement systolic excursion <10.9 mm and peak systolic myocardial velocity <6.3cm/s (lower normal limits among controls), respectively, indicating high prevalence of systolic functional impairment.
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