Pulmonary Valve Replacement for Regurgitation after Repair of Tetralogy of Fallot

Timing and type of surgery for severe pulmonary regurgitation after repair of tetralogy of Fallot

“…Since symptoms from RV failure may appear only when advanced and irreversible myocardial damage has occurred, early and subtler adverse effects of PR may be easily missed if the evaluation depends on clinical assessment alone [17,18]. Many authors have reported that severe long-term PR may result, despite the lack of symptoms, in progressive RV dilatation and dysfunction [16][17][18][19][20][21][22], and poor exercise tolerance [23][24][25][26]. Residual lesions like VSD, tricuspid regurgitation (TR), RVOT or branch pulmonary artery stenosis, and surgical sequelae-like conduction disturbances or resection of muscle during repair or RVOT patching, further impact on RV size and function [15,17,18,20,25,27,28].…”

“…Historically, the first reports on PVR and its beneficial effects appeared in the early 1980s, showing clinical improvement, with low operative risk [20,56].…”

“…When PR is associated with additional residual lesions, such as VSD, tricuspid regurgitation, RVOT stenosis or branch pulmonary artery stenosis, RV deterioration may be accelerated [18,20,27,28] and poorly tolerated [15,18,25]. In the case of distal obstruction of the pulmonary artery or its branches PR is not tolerated, even if moderate [12,28].…”

“Absent” pulmonary valve with atrial septal defect and patent ductus arteriosus

“…While these series are small, and the results encouraging, the potential problems from chronic pulmonary regurgitation have not been resolved . Recent data from Ebert and his co-workers [8] have shown that chronic pulmonary regurgitation in some postoperative TOF patients (not with APV) may lead to progressive RV failure unresponsive to medical management leading to valve insertion . In addition, Kirklin et al .…”

Right ventricular restrictive physiology in repaired tetralogy of Fallot is associated with smaller respiratory variability

“…On the other hand, reports concerning the late mortality and functional deterioration on long-term follow-up are emerging [1][2][3][4][5][6][7][8][9][10] and it has been well documented that the long-term outcome of patients with repaired TOF is related to right ventricular (RV) volume overload, severity of pulmonary insufficiency (PI) and the type of outflow repair [1][2][3][4][5][6][7][8][10][11][12]. Recently, a new concept of restrictive right ventricular physiology (RVRP) in repaired TOF patients had been introduced and known to be related to less RV dilatation, less prolongation of QRS duration, less symptomatic ventricular arrhythmia, and more favorable late outcome [9,13,14], but some conflicting results [15][16][17] have also been reported, and the relationships among the influencing factors are not clearly understood.…”