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YI-3 Early cardiac remodelling after pulmonary valve replacement in patients with repaired tetralogy of fallot
  1. Ee Ling Heng1,2,
  2. Michael A Gatzoulis1,2,
  3. Anselm Uebing1,
  4. Babulal Sethia1,
  5. Hideki Uemura1,
  6. Gillian C Smith2,
  7. Gerhard-Paul Diller3,
  8. Karen P McCarthy4,
  9. Siew Yen Ho4,
  10. Wei Li1,
  11. Piers Wright5,
  12. Veronica Spadotto1,6,
  13. Philip J Kilner2,
  14. Paul Oldershaw1,
  15. Dudley J Pennell2,
  16. Darryl F Shore1,2,
  17. Sonya V Babu-Narayan1,2
  1. 1Department of Adult Congenital Heart Disease, Royal Brompton Hospital, London, SW3 6NP, UK
  2. 2NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College London, SW3 6NP, UK
  3. 3Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital of Munster, Munster, D-48149, Germany
  4. 4Cardiac Morphology Unit, Royal Brompton Hospital, London, SW3 6NP, UK
  5. 5Non-Invasive Cardiology Department, Royal Brompton Hospital, London, SW3 6NP, UK
  6. 6Department of Thoracic and Cardiovascular Sciences, University of Padua, Padua, 35128, Italy

Abstract

Background Whilst pulmonary valve replacement (PVR) in patients with repaired tetralogy of Fallot (rTOF) is shown to provide symptomatic benefit and reduction of right ventricular (RV) volumes, there are scarce data on the rate of ventricular mechanical and biological adaptation. We aimed to assess early and late post-PVR volumetric and functional changes.

Methods and Results Patients with rTOF (≥16 years) for PVR were prospectively recruited for Cardiovascular Magnetic Resonance (CMR): pre-PVR (pPVR), early post-PVR at median 6 days (ePVR) and late post-PVR at median 3 years (mPVR).

Fifty-seven patients with rTOF (mean age 35.8 ± 10.1 years, 38 male) were included. There was an acute reduction in indexed RV end-diastolic (EDVi), end-systolic (ESVi) volumes and mass early post-PVR, which was sustained at latest time point (RVEDVi pPVR 156.1 ± 41.9ml/m² vs ePVR 104.9 ± 28.4ml/m² vs mPVR 104.2 ± 34.4ml/m2 and RVESVi pPVR 74.9 ± 26.2ml/m² vs ePVR 57.4 ± 22.7ml/m² vs mPVR 50.5 ± 21.7ml/m2;p < 0.01). Seventy percent of patients achieved postoperative normal range diastolic and systolic RV volumes which were predicted by a preoperative RVEDVi≤158ml/m2and RVESVi≤82ml/m2. PVR produced a stepwise reduction in RVESVi (load independent variable) together with an improvement in corrected RVEF after restoring valve competency (which is load dependent). There was also a modest but significant improvement of LVEF, as well as reverse right atrial remodelling.

Conclusions Cardiac remodelling is generally regarded as a gradual process post-PVR. We demonstrate for the first time that the major improvement in RV volumes seen at midterm follow-up have already taken place within days after surgery. This occurs with an apparent transient impairment of RVEF, although corrected RVEF more easily illustrates the immediate effect of PVR. However, RVESVi may be a more appropriate, load-independent marker that better reflects the early and sustained benefit of PVR on RV contractility.

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