PT  - JOURNAL ARTICLE
AU  - Kenichiro Yamamura
AU  - Darren Yuen
AU  - Edward J Hickey
AU  - Xiaolin He
AU  - Rajiv R Chaturvedi
AU  - Mark K Friedberg
AU  - Lars Grosse-Wortmann
AU  - Kate Hanneman
AU  - Filio Billia
AU  - Michael E Farkouh
AU  - Rachel M Wald
TI  - Right ventricular fibrosis is associated with cardiac remodelling after pulmonary valve replacement
AID  - 10.1136/heartjnl-2018-313961
DP  - 2018 Dec 04
TA  - Heart
PG  - heartjnl-2018-313961
4099  - http://heart.bmj.com/content/early/2018/12/04/heartjnl-2018-313961.short
4100  - http://heart.bmj.com/content/early/2018/12/04/heartjnl-2018-313961.full
AB  - Objective The relationship between right ventricular (RV) fibrosis and right heart reverse remodelling following pulmonary valve replacement (PVR) has not been well studied in adults with repaired tetralogy of Fallot (rTOF). Our aims were to histologically quantify RV fibrosis and to explore the relationship between fibrosis severity and cardiac remodelling post-PVR.Methods Adults with rTOF and pre-PVR cardiovascular (CMR) imaging were consented to procurement of RV muscle during PVR. Samples were stained with picrosirius red to quantify collagen volume fraction. Clinical data at baseline and at last follow-up were reviewed. Adverse cardiovascular outcomes included death, sustained arrhythmia and heart failure.Results Fifty-three patients (male 58%, 38±11 years) were studied. Those with severe fibrosis (collagen volume fraction >11.0%, n=13) had longer aortic cross-clamp times at initial repair compared with the remainder of the population (50 vs 33 min, p=0.018) and increased RV mass:volume ratio pre-PVR (0.20 vs 0.18 g/mL, p=0.028). Post-PVR, the severe fibrosis group had increased indexed RV end-systolic volume index (RVESVi) (74 vs 66 mL/m2, p=0.044), decreased RVESVi change (Δ29 vs Δ45 mL/m2, p=0.005), increased RV mass (34 vs 25 g/m2, p=0.023) and larger right atrial (RA) area (21 vs 17 cm2, p=0.021). A trend towards increased heart failure events was observed in the severe fibrosis group (15% vs 0%, p=0.057).Conclusions Severe RV fibrosis was associated with increased RVESVi, RV mass and RA area post-PVR in rTOF. Further study is required to define the impact of fibrosis and persistent right heart enlargement on clinical outcomes.