Tetralogy of Fallot is the most common cyanotic congenital heart disease. Late after corrective surgery, patients are at risk of developing right ventricular (RV) failure due to pulmonary valve regurgitation and arrhythmias related to surgical scars and ventricular electrophysiological remodeling. Pulmonary valve replacement has been identified as an interesting strategy to reduce RV dilatation but its impact on the arrhythmic risk remains uncertain. We sought to determine whether percutaneous pulmonary valve implantation (PPVI) at an early pathological stage leads to benefical effects on right and left ventricular electrophysiological remodeling in a porcine model of repaired tetralogy of Fallot (rTOF). Piglets (<10 kg) underwent pulmonary artery banding, pulmonary valve disruption to induce RV hypertrophy and dilatation and a PTFE patch was sewn across the pulmonary annulus. Two-months later, PPVI was performed in a sub-group of rTOF pigs. At 3 months post-surgery, cardiac function was assessed by MRI in rTOF, rTOF-PPVI and Sham-operated pigs. Animals were euthanized and optical mapping of isolated left and right ventricles electrical activity was performed using the voltage-sensitive dye Di-4-ANEPPS. Expression of selected genes was assessed by quantitative RT-PCR. At 3 months post-surgery, pulmonary artery regurgitation, RV end-diastolic and end-systolic volumes normalized to body surface area were significantly increased in rTOF pigs compared to Sham animals. In rTOF-PPVI animals these parameters were partially reversed and not statistically different from Sham pigs. An action potential prolongation was observed in both the left ventricle and the RV epicardium but not in the endocardium of rTOF pigs. Within the RV epicardium, this prolongation was mainly confined to the anterior side. Interestingly, rTOF-PPVI pigs action potential durations were similar to Sham animals. In line with functional investigations, a large increase in BNP expression was found in rTOF RV compared to Sham pigs (fold change = 34) which was not as pronounced in rTOF-PPVi pigs (fold change = 3) while a lower expression of KCND3 and KCNJ2 was found in rTOF pigs. In our rTOF porcine model, PPVI at an early pathological stage reversed RV dilatation. It also successfully reversed action potential prolongation in the left ventricle and the anterior RV epicardium, and may thus have beneficial effects on the arrhythmic risk.
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