Magnetic Resonance Imaging to Assess the Hemodynamic Effects of Pulmonary Valve Replacement in Adults Late After Repair of Tetralogy of Fallot

Abstract

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%

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“…The group of patients subjected to PPVI is varied in terms of primary diagnosis, symptoms, number of interventions, type of dominant lesion, and anatomy of the heart. Investigators try to define the baseline characteristics related to an improvement after PPVI, most typically acknowledged by the assessment of ventricular end-systole and end--diastole volumes, or CPET [11][12][13][14]. The reported factors that are believed to influence short-and/or long-term results include: type of dominant lesion [4,15]; baseline RVEDV [16,17]; and baseline peak VO 2 value [18].…”

Aetiology, diagnosis and management of heart failure in infants and children

“…Pulmonary valve incompetence is usually seen in patients with tetralogy of Fallot following repair. (14) …”

Timing and Technique of Pulmonary Valve Replacement in the Patient With Tetralogy of Fallot

“…By 1996, it was used to measure RV volume in repaired TOF. 17,20 Vliegen and colleagues 21 showed that PR was eliminated and RV volume was reduced following PVR. However, the authors noted that the RV did always decrease to normal size.…”

“…However, the authors noted that the RV did always decrease to normal size. 21 In 2005, Therrien and colleagues 22 showed that once the RV end-diastolic volume (RVEDV) reached 170 mL/m 2 and the RV end-systolic volume (RVESV) reached 85 mL/m 2 that remodeling to normal size following PVR was unlikely (Fig. 5).…”