Pulmonary Valve Replacement in Adult Patients With a Severely Dilated Right Ventricle and Refractory Arrhythmias After Repair of Tetralogy of Fallot

Miyazaki, Aya; Yamamoto, Masaki; Sakaguchi, Heima; Tsukano, Shinya; Kagisaki, Koji; Suyama, Kazuhiro; Ohuchi, Hideo; Kurosaki, Kenichi; Yagihara, Toshikatsu; Yamada, Osamu

doi:10.1253/circj.cj-09-0164

Cited by 16 publications

(5 citation statements)

References 28 publications

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“…Some studies however had limited improvement in survival rate and incidences of ventricular tachycardia [4,5]. Progressive fibrosis is suspected to play a pathological role in development of ventricular arrhythmias on long-term follow-up after primary repair [6,7].…”

Section: Discussionmentioning

confidence: 99%

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Myocardial hypertrophy after pulmonary regurgitation and valve implantation in pigs

Smith

Goetze

Søndergaard

et al. 2012

International Journal of Cardiology

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Section: Discussionmentioning

confidence: 99%

“…The right ventricle does, however, not always completely recover following late pulmonary valve replacement with sustained risk of refractory arrhythmia and RV dysfunction [4,5]. The cellular mechanisms of the reverse remodelling process are not well understood.…”

Section: Introductionmentioning

confidence: 99%

Myocardial hypertrophy after pulmonary regurgitation and valve implantation in pigs

Smith

Goetze

Søndergaard

et al. 2012

International Journal of Cardiology

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“…PVR was performed in 5 patients, which resulted in complete control of tachyarrhythmia in 2 patients and partial control of tachyarrhythmia in 3 patients with severe RV dilatation. 15 At the end of follow-up, 20 of 21 patients (95%) required AADs even after other effective treatments. Among 3 patients with failed control of tachyarrhythmia, 1 died suddenly, 1 died from heart failure, and 1 died from sepsis.…”

Section: Treatment For Tachyarrhythmiamentioning

confidence: 98%

Efficacy of Hemodynamic-Based Management of Tachyarrhythmia After Repair of Tetralogy of Fallot

Miyazaki

Sakaguchi

Ohuchi

et al. 2012

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp ate complications following repair of tetralogy of Fallot (TOF) include arrhythmia, exercise intolerance, heart failure and death. 1-5 In particular, tachyarrhythmia is a major concern after TOF repair and is associated with an increased risk of sudden death. 2-4,6,7 Risk factors for sudden death and sustained ventricular tachycardia (VT) include older age at the time of repair, QRS duration ≥180 ms, additional right ventricular (RV) structural abnormalities (outflow tract aneurysms and pulmonary or tricuspid regurgitation), positive programmed ventricular stimulation, and severe RV dilatation with either left ventricular (LV) or RV dysfunction. 3,6,8-11There is a relatively low incidence, however, of serious late problems after TOF repair in the Japanese population. The actuarial survival rate after repair of TOF at 30 years was 98% in a Japanese multicenter study, 12 compared with 80% and 89% in large studies from Western countries. 1,4 Further, the incidence of sustained VT and atrial tachycardia/atrial fibrillation (AT/AF) was 0.4% and 3%, respectively, in Japan, 12 compared with 4% and 4-20%, respectively, in Western countries. 2,3,7,13 In addition, many repaired TOF patients in Japan have fairly good postoperative RV function, while the proportion of patients with QRS duration <120 ms and cardiothoracic ratio (CTR) <59% has been reported to be 60% and 61%, respectively. 12 Therefore, in Japan, hemodynamic assessments tend to be underestimated for patients late after repair of TOF. Given that patient characteristics late after repair of TOF in Japan differ from those in other countries, it is important to consider a different treatment strategy from those used in other coun-L

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“…With advancements in PVR technology, it is widely accepted to perform PVR before irreversible RV dilatation and heart function deterioration occurs in patients with rTOF [9][10][11]. Previous studies have shown that the cumulative incidence of long-term reoperation in patients with rTOF is 44%, with a median of 24 years after the initial repair [12,13].…”

Section: Preoperative Clinical Featuresmentioning

confidence: 99%

Right ventricular dilatation score: a new assessment to right ventricular dilatation in adult patients with repaired tetralogy of Fallot

Zhou,

Huang,

Han

et al. 2023

BMC Cardiovasc Disord

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Background Patients with repaired tetralogy of Fallot (rTOF) experience long-term chronic pulmonary valve regurgitation resulting in right ventricular (RV) dilatation. According to current guidelines, the evaluation of patients with rTOF for RV dilatation should be based on cardiac magnetic resonance (CMR). However, for many asymptomatic patients, routine CMR is not practical. Our study aims to identify screening methods for CMR based on echocardiographic data, with the goal of establishing a more practical and cheap method of screening for severity of RV dilatation in patients with asymptomatic rTOF. Methods Thirty two rTOF patients (mean age, 21(10.5) y, 21 males) with moderate to severe pulmonary regurgitation (PR) were prospectively recruited. Each patient received CMR and echocardiogram examination within 1 month prior to operation and collected clinical data, and then received echocardiogram examination at discharge and 3–6 months post-surgery. Results RV moderate-severe dilatation was defined as right ventricular end-diastolic volume index (RVEDVI) ≥ 160 ml/m2 or right ventricular end-systolic volume index (RVESVI) ≥ 80 ml/m2 in 15 of 32 patients (RVEDVI, 202.15[171.51, 252.56] ml/m2, RVESVI, 111.99 [96.28, 171.74] ml/m2). The other 17 (RVESDI, 130.19 [117.91, 139.35] ml/m2, RVESVI = 67.91 [63.35, 73.11] ml/m2) were defined as right ventricle mild dilatation, i.e., RVEDVI < 160 ml/m2 and RVESVI < 80 ml/m2, and the two parameters were higher than normal values. Compared with the RV mild dilatation group, patients of RV moderate-severe dilatation have worse cardiac function before surgery (right ventricular ejection fraction, 38.92(9.19) % versus 48.31(5.53) %, p < 0.001; Left ventricular ejection fraction, 59.80(10.26) versus 66.41(4.15), p = 0.021). Patients with RV moderate-severe dilatation faced longer operation time and more blood transfusion during operation (operation time, 271.53(08.33) min versus 170.53(72.36) min, p < 0.01; Intraoperative blood transfusion, 200(175) ml versus 100(50) ml, p = 0.001). Postoperative RV moderate-severe dilatation patients have poor short-term prognosis, which was reflected in a longer postoperative hospital stay (6.59 [2.12] days versus 9.80 [5.10] days, p = 0.024) and a higher incidence of hypohepatia (0[0] % versus 4[26.7] %, p = 0.023). Patients with RV dilatation score > 2.35 were diagnosed with RV moderate-severe dilatation (AUC = 0,882; Sensitivity = 94.1%; Specificity = 77.3%). Conclusions RV moderate-severe dilatation is associated with worse preoperative cardiac function and short-term prognosis after PVR in rTOF patients with moderate to severe PR. The RV dilatation score is an effective screening method. When RV dilatation score > 2.35, the patient is indicated for further CMR examination and treatment.

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Pulmonary Valve Replacement in Adult Patients With a Severely Dilated Right Ventricle and Refractory Arrhythmias After Repair of Tetralogy of Fallot

Cited by 16 publications

References 28 publications

Myocardial hypertrophy after pulmonary regurgitation and valve implantation in pigs

Myocardial hypertrophy after pulmonary regurgitation and valve implantation in pigs

Efficacy of Hemodynamic-Based Management of Tachyarrhythmia After Repair of Tetralogy of Fallot

Right ventricular dilatation score: a new assessment to right ventricular dilatation in adult patients with repaired tetralogy of Fallot

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