CLINICAL STUDY
Pulmonary valve replacement in adults late after repair of tetralogy of Fallot: are we operating too late?
Judith Therrien, MD, FRCP(C)a,
Samuel C. Siu, MD, FRCP(C)a,
Peter R. McLaughlin, MD, FRCP(C)a,
Peter P. Liu, MD, FRCP(C)a,
William G. Williams, MD, FRCS(C)a and
Gary D. Webb, MD, FRCP(C)a
a University of Toronto Congenital Cardiac Center for Adults, Toronto, Ontario, Canada
Manuscript received September 20, 1999;
revised manuscript received April 17, 2000,
accepted June 16, 2000.
Reprint requests and correspondence: Dr. Judith Therrien, The Sir Mortimer B Davis Jewish General Hospital, 3755 Cote Ste Catherine, Room E-206, Montreal, Quebec, H3T 1E2, Canada
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.
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Abbreviations and Acronyms
| | 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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T. Oosterhof, J.W.J. Vriend, B.J.M. Mulder, A. Frigiola, S. Cullen, A. Redington, and M. Vogel
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V. Gober, P. Berdat, M. Pavlovic, J.-P. Pfammatter, and T. P. Carrel
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S K Srinathan, R S Bonser, B Sethia, S A Thorne, W J Brawn, and D J Barron
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A. van Straten, H. W. Vliegen, M. G. Hazekamp, J. J. Bax, P. H. Schoof, J. Ottenkamp, E. E. van der Wall, and A. de Roos
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A. A. Ali, J. C. Halstead, A.-R. Hosseinpour, Z. A. Ali, S. Kumar, and J. Wallwork
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A. Frigiola, A.N. Redington, S. Cullen, and M. Vogel
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C. Lim, J. Y. Lee, W.-H. Kim, S.-C. Kim, J.-Y. Song, S.-J. Kim, J.-H. Choh, and C. Whan Kim
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T. Geva, B. M. Sandweiss, K. Gauvreau, J. E. Lock, and A. J. Powell
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K. G. Warner, P. K. H. O'Brien, J. Rhodes, A. Kaur, D. A. Robinson, and D. D. Payne
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J. Q. Zhou, A. F. Corno, C. H. Huber, P. Tozzi, and L. K. von Segesser
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J. Heggie, N. Poirer, W. G. Williams, and J. Karski
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T. Kuehne, M. Saeed, C. B. Higgins, K. Gleason, G. A. Krombach, O. M. Weber, A. J. Martin, D. Turner, D. Teitel, and P. Moore
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H. Laks, D. Marelli, M. Plunkett, J. Odim, and J. Myers
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P. A. Davlouros, P. J. Kilner, T. S. Hornung, W. Li, J. M. Francis, J. C. C. Moon, G. C. Smith, T. Tat, D. J. Pennell, and M. A. Gatzoulis
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H. W. Vliegen, A. van Straten, A. de Roos, A. A.W. Roest, P. H. Schoof, A. H. Zwinderman, J. Ottenkamp, E. E. van der Wall, and M. G. Hazekamp
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G. A. Varaprasathan, P. A. Araoz, C. B. Higgins, and G. P. Reddy
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K. R. Kanter, J. M. Budde, W. J. Parks, V. K.H. Tam, S. Sharma, W. H. Williams, and D. A. Fyfe
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P. Bonhoeffer, Y. Boudjemline, S. A. Qureshi, J. Le Bidois, L. Iserin, P. Acar, J. Merckx, J. Kachaner, and D. Sidi
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T. Kuehne, M. Saeed, G. Reddy, H. Akbari, K. Gleason, D. Turner, D. Teitel, P. Moore, and C. B. Higgins
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H. Ohuchi, K. Yasuda, S. Hasegawa, A. Miyazaki, M. Takamuro, O. Yamada, Y. Ono, H. Uemura, T. Yagihara, and S. Echigo
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Y. d'Udekem, J. Rubay, and C. Ovaert
Failure of right ventricular recovery of Fallot patients after pulmonary valve replacement: delay of reoperation or surgical technique?
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J. Therrien, G. Webb, and W. G. Williams
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J. Therrien, S. C. Siu, L. Harris, A. Dore, K. Niwa, J. Janousek, W. G. Williams, G. Webb, and M. A. Gatzoulis
Impact of Pulmonary Valve Replacement on Arrhythmia Propensity Late After Repair of Tetralogy of Fallot
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A. A. W. Roest, W. A. Helbing, P. Kunz, J. G. van den Aardweg, H. J. Lamb, H. W. Vliegen, E. E. van der Wall, and A. de Roos
Exercise MR Imaging in the Assessment of Pulmonary Regurgitation and Biventricular Function in Patients after Tetralogy of Fallot Repair
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