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Background Cardiac MRI (CMR) derived ventricular global function index (GFI), a ratio of stroke volume to the sum of mean ventricular cavity and myocardial volumes, has demonstrated improved prediction of clinical outcomes in adults with atherosclerotic disease over ejection fraction. We sought to assess CMR derived GFI and a novel modification that accounts for unique loading conditions in patients with repaired tetralogy of Fallot (rTOF) and determine its correlation with exercise performance. Methods and Results Seventy‐five patients with rTOF who underwent CMR were identified. Clinical variables were recorded and biventricular GFI calculated. A right ventricular (RV) effective GFI (eGFI) was derived by incorporating effective stroke volume. Thirty‐five pediatric patients were matched with 29 age‐matched healthy controls. Twenty‐five patients completed cardiopulmonary exercise tests within 6 months of CMR. Stepwise regression models were used to determine univariate and multivariable predictors of indexed and percent predicted peak VO 2 . Median age at CMR was 20 years (interquartile range, 13–28). Pediatric rTOF patients had lower RV eGFI ( P < 0.001), RV ejection fraction ( P =0.002), but higher indexed RV end‐diastolic and end‐systolic volumes ( P < 0.001, P < 0.001) compared with controls. Univariate analysis demonstrated a correlation between indexed peak VO 2 with RV eGFI ( R 2 =0.32, P =0.004), but with neither RVGFI, RV ejection fraction, indexed RV volumes nor RV mass. RV eGFI remained significantly associated with indexed peak VO 2 during multivariable modeling. Conclusions Reduced RV eGFI was associated with reduced exercise capacity in rTOF patients, while RV GFI, RV ejection fraction, indexed RV volumes and mass were not. Our modification of the GFI, RV eGFI, may be a valuable non‐invasive marker of cardiac function in rTOF.

Background Discussions continue as to whether ventricular septal defects are best categorized according to their right ventricular geography or their borders. This is especially true when considering the perimembranous defect. Our aim, therefore, was to establish the phenotypic feature of the perimembranous defect, and to establish the ease of distinguishing its geographical variants. Methods and results We assessed unrepaired isolated perimembranous ventricular defects from six historic archives, subcategorizing them using the ICD-11 coding system. We identified 365 defects, of which 94 (26%) were deemed to open centrally, 168 (46%) to open to the outlet, and 84 (23%) to the inlet of the right ventricle, with 19 (5%) being confluent. In all hearts, the unifying phenotypic feature was fibrous continuity between the leaflets of the mitral and tricuspid valves. This was often directly between the valves, but in all instances incorporated continuity through the atrioventricular portion of the membranous septum. In contrast, we observed fibrous continuity between the leaflets of the tricuspid and aortic valves in only 298 (82%) of the specimens. When found, discontinuity most commonly was seen in the outlet and central defects. There were no discrepancies between evaluators in distinguishing the borders, but there was occasional disagreement in determining the right ventricular geography of the defect. Conclusions The unifying feature of perimembranous defects, rather than being aortic-to-tricuspid valvar fibrous continuity, is fibrous continuity between the leaflets of the atrioventricular valves. While right ventricular geography is important in classification, it is the borders which are more objectively defined.

We describe a new and unique method for simultaneous determination of the groove depth and duty cycle of binary diffraction gratings. For a near-normal angle of incidence, the +1 and -1 diffracted orders will behave nearly the same as the duty cycle is varied for a fixed grating depth. The difference in their behavior, quantified as the ratio of their respective diffraction efficiencies, is compared to a look-up table generated by rigorous coupled-wave theory, and the duty cycle of the grating is thus obtained as a function of grating depth. Performing the same analysis for the orthogonal probe-light polarization results in a different functional dependence of the duty cycle on the grating depth. By use of both TE and TM polarizations, the depth and duty cycle for the grating are obtained by the intersection of the functions generated by the individual polarizations. These measurements can also be used to assess qualitatively both the uniformity of the grating and the symmetry of the grating profile. Comparison with scanning electron microscope images shows excellent agreement. This method is advantageous since it can be carried out rapidly, is accurate and repeatable, does not damage the sample, and uses low-cost, commonly available equipment. Since this method consists of only four fixed simple measurements, it is highly suitable for quality control in a manufacturing environment.