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Original research
Outcome and right ventricle remodelling after valve replacement for pulmonic stenosis
  1. Emilie Laflamme,
  2. Rachel M Wald,
  3. S Lucy Roche,
  4. Candice K Silversides,
  5. Sara A Thorne,
  6. Jack M Colman,
  7. Lee Benson,
  8. Mark Osten,
  9. Eric Horlick,
  10. Erwin Oechslin,
  11. Rafael Alonso-Gonzalez
  1. Toronto ACHD Program, University Health Network, Toronto, Ontario, Canada
  1. Correspondence to Dr Rafael Alonso-Gonzalez, Toronto ACHD Program, University Health Network, Toronto, ON M5G 2N2, Canada; rafa.alonso{at}uhn.ca

Abstract

Background Complications and need for reinterventions are frequent in patients with pulmonary valve stenosis (PVS). Pulmonary regurgitation is common, but no data are available on outcome after pulmonary valve replacement (PVR).

Methods We performed a retrospective analysis of 215 patients with PVS who underwent surgical valvotomy or balloon valvuloplasty. Incidence and predictors of reinterventions and complications were identified. Right ventricle (RV) remodelling after PVR was also assessed.

Results After a median follow-up of 38.6 (30.9–49.4) years, 93% of the patients were asymptomatic. Thirty-nine patients (18%) had at least one PVR. Associated right ventricular outflow tract (RVOT) intervention and the presence of an associated defect were independent predictors of reintervention (OR: 4.1 (95% CI 1.5 to 10.8) and OR: 3.6 (95% CI 1.9 to 6.9), respectively). Cardiovascular death occurred in 2 patients, and 29 patients (14%) had supraventricular arrhythmia. Older age at the time of first intervention and the presence of an associated defect were independent predictors of complications (OR: 1.0 (95% CI 1.0 to 1.1) and OR: 2.1 (95% CI 1.1 to 4.2), respectively). In 16 patients, cardiac magnetic resonance before and after PVR was available. The optimal cut-off values for RV volume normalisation were 193 mL/m2 for RV end-diastolic volume indexed(sensitivity 80%, specificity 64%) and 100 mL/m2 for RV end-systolic volume indexed(sensitivity 80%, specificity 56%).

Conclusions Previous RVOT intervention, presence of an associated defect and older age at the time of first repair were predictors of outcome. More data are needed to guide timing of PVR, and extrapolation of tetralogy of Fallot guidelines to this population is unlikely to be appropriate.

  • heart defects
  • congenital
  • pulmonary valve stenosis
  • pulmonary valve insufficiency

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Contributors EL and RA-G contributed to the conception and design of the study. EL contributed to data acquisition. EL and RA-G performed the statistical analysis and wrote the first draft. RW, LR, CKS, ST, JMC, LB, MO, EH and EO provided critical revision. EL and RA-G edited the final manuscript. EL and RA-G are responsible for the overall content and act as guarantors.

  • Funding EL's clinical/research fellowship was funded by la Fondation de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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