Background-To facilitate the optimal timing of pulmonary valve replacement, we analyzed preoperative thresholds of right ventricular (RV) volumes above which no decrease or normalization of RV size takes place after surgery. Methods and Results-Between 1993 and 2006, 71 adult patients with corrected tetralogy of Fallot underwent pulmonary valve replacement in a nationwide, prospective follow-up study. Patients were evaluated with cardiovascular magnetic resonance both preoperatively and postoperatively. Changes in RV volumes were expressed as relative change from baseline. RV volumes decreased with a mean of 28%. RV ejection fraction did not change significantly after surgery (from 42Ϯ10% to 43Ϯ10%; Pϭ0.34). Concomitant RV outflow tract reduction resulted in a 25% larger decrease of RV volumes. After correction for surgical RV outflow tract reduction, higher preoperative RV volumes (mL/m 2 ) were independently associated with a larger decrease of RV volumes (RV end-diastolic volume: ␤ϭ0.41; PϽ0.001). Receiver operating characteristic analysis revealed a cutoff value of 160 mL/m 2 for normalization of RV end-diastolic volume or 82 mL/m 2 for RV end-systolic volume. Conclusions-Overall, we could not find a threshold above which RV volumes did not decrease after surgery. Preoperative RV volumes were independently associated with RV remodeling and also when corrected for a surgical reduction of the RV outflow tract. However, normalization could be achieved when preoperative RV end-diastolic volume was Ͻ160 mL/m 2 or RV end-systolic volume was Ͻ82 mL/m 2 . (Circulation. 2007;116:545-551.)

3D models are accurate replicas of the cardiovascular anatomy and improve the understanding of complex CHD. 3D models did not change the surgical decision in most of the cases (21 of 40 cases, 52.5% cases). However, in 19 of the 40 selected complex cases, 3D model helped redefining the surgical approach.

Background-Pulmonary regurgitation (PR) late after total correction for tetralogy of Fallot may lead to progressive right ventricular (RV) dilatation and an increased incidence of severe arrhythmias and sudden death. Timing of pulmonary valve replacement (PVR) is subject to discussion, because the effect of PVR on RV function in adults is unclear. In this study, MRI was used to assess the effect of PVR on RV function and PR. Clinical improvement was established by means of the NYHA classification. Methods and Results-Twenty-six adult patients were included. Cardiac MRI was performed at a median of 5.1Ϯ3.4 months before and 7.4Ϯ2.4 months after PVR. Mean preoperative PR was 46Ϯ10% (range, 25% to 64%). After PVR, 20 of 26 patients (77%) showed no residual PR, 5 patients showed mild residual PR, and 1 patient showed moderate PR. RV end-diastolic volume (RV-EDV) decreased from 305Ϯ87 to 210Ϯ62 mL (PϽ0.001), and RV end-systolic volume (RV-ESV) decreased from 181Ϯ67 to 121Ϯ58 mL (PϽ0.001). No significant change was found in RV-EF (42% versus 42%