Abstract
Although pulmonary valve replacement (PVR) improves ventricular function and symptoms, the benefit and optimal timing of PVR are controversial. This study aimed to evaluate early response to PVR for right ventricle (RV) dilatation and QRS duration. Retrospective analysis was performed for 32 patients with repaired tetralogy of Fallot (TOF) between March 2005 and October 2017. The differences between preoperative and postoperative changes in echocardiographic parameters, clinical symptoms, and QRS duration were evaluated. There were no in-hospital or late deaths. Mean age at the time of PVR was 16.57 ± 7.97 years. The interval between TOF repair and PVR was 12.99 ± 7.06 years. Postoperative echocardiographic findings showed significant reduction in indexed RV end-diastolic diameter (RV-EDDI) and the ratio of RV/LV-EDDI (P = 0.001 and P = 0.001, respectively). Higher preoperative RV-EDDI was associated with decreased change in RV-EDDI after PVR (r = 0.63; P = 0.001). Normalization of RV diameters was found to be independent of age at PVR, interval between TOF repair and PVR, preoperative QRS duration, and preoperative RV-EDDI. Significant improvement in RV diameter and symptoms could be obtained with PVR in patients with severe pulmonary regurgitation.
Highlights
Higher preoperative right ventricular (RV)-EDDI was associated with decreased change in RV end-diastolic diameter (RV-EDDI) after pulmonary valve replacement (PVR) (r = 0.63; P = 0.001)
Normalization of RV diameters was found to be independent of age at PVR, interval between tetralogy of Fallot (TOF) repair and PVR, preoperative QRS duration, and preoperative RV-EDDI
Significant improvement in RV diameter and symptoms could be obtained with PVR in patients with severe pulmonary regurgitation
Summary
An increase in the number of tetralogy of Fallot (TOF) repair survivors led to an increase in surgical reintervention as relief of right ventricular (RV) outflow tract obstruction often results in severe pulmonary regurgitation (PR), especially in those repaired with a transannular patch [1]. Chronic RV volume overload due to severe PR causes RV dilatation and dysfunction, right heart failure, ventricular arrhythmias, and death [2]. Restoration of pulmonary valve competency via pulmonary valve replacement (PVR) can lead to improvement in symptoms of RV failure, reduction and normalization in RV volume, and reduction of QRS duration and ventricular arrhythmias [3,4]. The current indication for PVR is the presence of symptoms in patients with severe PR, but optimal timing of PVR in asymptomatic patients remains controversial [5,6]. Cardiovascular magnetic resonance (CMR) has become the gold standard for evaluation of RV volumes and for deciding indications for intervention.
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