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J Am Coll Cardiol, 2000; 36:1670-1675
© 2000 by the American College of Cardiology Foundation
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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.

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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