Clinical study
Pulmonary valve replacement in adults late after repair of tetralogy of Fallot: are we operating too late?

https://doi.org/10.1016/S0735-1097(00)00930-XGet rights and content
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Abstract

OBJECTIVES

The purpose of this study is to evaluate right ventricular (RV) volume and function after pulmonary valve replacement (PVR) and to address the issue of optimal surgical timing in these patients.

BACKGROUND

Chronic pulmonary regurgitation (PR) following repair of tetralogy of Fallot (TOF) leads to RV dilation and an increased incidence of sudden cardiac death in adult patients.

METHODS

We studied 25 consecutive adult patients who underwent PVR for significant PR late after repair of TOF. Radionuclide angiography was performed in all at a mean of 8.2 months (± 8 months) before PVR and repeated at a mean of 28.0 months (± 22.8 months) after the operation. Right ventricular (RV) end-systolic volume (RVESV), RV end-diastolic volume (RVEDV) and RV ejection fraction (RVEF) were measured.

RESULTS

Mean RVEDV, RVESV and RVEF remained unchanged after PVR (227.1 ml versus 214.9 ml, p = 0.74; 157.4 ml versus 155.4 ml, p = 0.94; 35.6% versus 34.7%, p = 0.78, respectively). Of the 10 patients with RVEF ≥ 0.40 before PVR, 5 patients (50%) maintained a RVEF ≥ 0.40 following PVR, whereas only 2 out of 15 patients (13%) with pre-operative values <0.40 reached an RVEF ≥ 0.40 postoperatively (p < 0.001).

CONCLUSIONS

Right ventricular recovery following PVR for chronic significant pulmonary regurgitation after repair of TOF may be compromised in the adult population. In order to maintain adequate RV contractility, pulmonary valve implant in these patients should be considered before RV function deteriorates.

Abbreviations

LV
left ventricular, left ventricle
MRI
magnetic resonance imaging
PR
pulmonary regurgitation
PVR
pulmonary valve replacement
RNA
radionuclide angiography, radionuclide angiogram
RV
right ventricular, right ventricle
RVEDV
right ventricular end-diastolic volume
RVEF
right ventricular ejection fraction
RVESV
right ventricular end-systolic volume
RVOT
right ventricular outflow tract
TOF
Tetralogy of Fallot

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Supported by the Canadian Life and Manu Life Adult Congenital Heart Disease Fellowship