Pulmonary Valve Replacement in Tetralogy of Fallot

Weinberg, Catherine R.; McElhinney, Doff B.

doi:10.1161/circulationaha.114.005551

Cited by 21 publications

(11 citation statements)

References 23 publications

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“…The remodeling process can be reversed in some patients with PR by valve replacement . In a study of 170 patients with severe chronic PR, there were significant reductions in RV volumes and improvement in RV systolic function following pulmonary valve replacement.…”

Section: Case Reportmentioning

confidence: 99%

“…PR is usually well tolerated for many years but can be associated with late morbidity and mortality related to RV dilation, RV dysfunction, secondary tricuspid regurgitation, development of atrial or ventricular arrhythmias, and/or deteriorating exercise capacity. Percutaneous pulmonary valve implantation has be associated with hemodynamic improvement in patients with severe PR following Tetralogy of Fallot repair .…”

Section: Case Reportmentioning

confidence: 99%

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Causes and hemodynamic findings in chronic severe pulmonary regurgitation

Rommel

Yadav

Stouffer

2015

Cathet Cardio Intervent

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Severe pulmonary regurgitation (PR) most commonly occurs as a sequelae of treatment of pulmonic stenosis or Tetralogy of Fallot with fewer cases of primary pulmonic valvular regurgitation. The amount of PR is influenced by valvular integrity, right ventricular (RV) size, and RV diastolic pressures. In chronic severe PR, the RV remodels to accommodate the regurgitant flow and RV stroke volume increases to maintain effective forward blood flow. Hemodynamic changes include a widened pulmonary artery (PA) pulse pressure and low PA diastolic pressures. As the amount of regurgitation increases, RV end diastolic pressure becomes elevated and systemic cardiac output is reduced, especially with exercise. "Ventricularization" of the PA pressure tracing, in which the contour of the PA pressure is similar to the contour of the RV pressure, is a specific but not sensitive finding in severe PR. © 2015 Wiley Periodicals, Inc.

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Section: Case Reportmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

Causes and hemodynamic findings in chronic severe pulmonary regurgitation

Rommel

Yadav

Stouffer

2015

Cathet Cardio Intervent

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“…The surgery includes the infundibulotomy with or without trans-valve repair. PR is the most serious complication after the surgical repair, persistent PR might lead to RV dilatation, ventricular arrhythmias, and even cardiac event decades 10 , 17 – 21 . ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease point out that pulmonary valve replacement (PVR) is reasonable in adults with previous tetralogy of Fallot, severe pulmonary regurgitation, and any of the following: a. moderate to severe RV dysfunction or RV enlargement; b. development of symptomatic or sustained arrhythmias; c. moderate to severe tricuspid regurgitation 22 .…”

Section: Discussionmentioning

confidence: 99%

Computed tomography for evaluating right ventricle and pulmonary artery in pediatric tetralogy of Fallot: correlation with post-operative pulmonary regurgitation

Gao

Yang

Shi

et al. 2018

Sci Rep

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Pulmonary regurgitation (PR) is the most common complication after tetralogy of Fallot (TOF) surgical repair, and long-term PR might result in cardiovascular events. The aim of this study was to assess the influence of pre-operative right ventricle (RV) and pulmonary artery (PA) parameters assessed by dual-source computed tomography on post-operative PR. A total of 41 TOF patients who underwent trans-valve surgical repair were retrospectively recruited. The RV and PA parameters evaluated by pre-operative DSCT were compared between the PR and non-PR groups. Our result revealed that the PA parameters (McGoon ratio, Nakata index, and LPA diameter) and RV parameters (RV length diameter and RV short diameter) all showed significant differences between the two groups (all p < 0.05). There was a significant correlation between PR and LPA diameter (r = 0.361), McGoon ratio (r = 0.413), and Nakata index (r = 0.482). Receiver operating characteristic analysis also revealed a moderate sensitivity and specificity of LPA (66.33%; 82.60%), McGoon ratio (83.33%, 56.52%), and Nakata index (83.33%; 60.87%) for predicting the occurrence of PR. This study indicated that these pre-operative indices calculated by DSCT are associated with post-operative PR and that these pre-operative PA and RV parameters may serve as novel predictors of the risk of PR.

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“…[4] On the other hand, the operated TOF patients still face the risk of a secondary procedure related to pulmonary valve insufficiency. [1,2] In the past, TOF procedure-related pulmonary valve insufficiency was believed to be harmless to the cardiac functions in the postoperative period; however, with the use of innovative screening methods such as cardiac MRI, it is now widely accepted that chronic pulmonary valve insufficiency deteriorates the right ventricular functions. [5] Gatzoulis et al [5] demonstrated that pulmonary valve insufficiency caused right ventricular dilatation and dysfunction, intolerance to exercise, newly developing arrhythmias, and even sudden death over time.…”

Section: Discussionmentioning

confidence: 99%

“…[1,2] Surgery of TOF has been performed with low morbidity and mortality rates, in parallel with the evolution in cardiac surgery and postoperative care fields. [1,2] Despite these improvements in TOF surgery, however, reoperation is inevitable in nearly 50% of survivors in the following three decades after the initial procedure. [3] The most frequent reoperation is the pulmonary valve replacement (PVR) which is performed for chronic pulmonary valve insufficiency.…”

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confidence: 99%

Early surgical outcome of pulmonary valve replacement in patients with previous right ventricle outflow tract reconstruction

Sarıtaş¹

2017

Turk Gogus Kalp Dama

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ÖZAmaç: Bu çalışmada sağ ventrikül çıkım yolu rekonstrüksiyonu yapılan hastalarda erken dönem pulmoner kapak replasmanı cerrahi sonuçlarımız sunuldu.Ça lış ma pla nı: Ocak 2009 -Eylül 2016 tarihleri arasında sağ ventrikül çıkım yolu rekonstrüksiyonu sonrasında pulmoner yetmezlik nedeniyle 76 hastaya (34 erkek, 42 kadın; ort. yaş 11.4±5.8 yıl; dağılım 7-18 yıl) pulmoner kapak replasmanı yapıldı. Kronik pulmoner yetmezlikli 54 semptomatik hastada cerrahi endikasyon semptomların sağ ventrikül volüm yüklenmesi ile ilişkili egzersiz intoleransı veya aritmi veya pulmoner arter dallarında darlık ile birlikte veya tek başına fonksiyon bozukluğu gibi semptomlar idi. Asemptomatik 22 hastada cerrahi endikasyon, manyetik rezonans görüntülemeye göre belirlendi. Bul gu lar:Ortalama takip süresi 60±19 (dağılım 17-108) ay idi. Erken ve geç dönem mortalite gözlenmedi. Ameliyat sonrası dönemde semptomatik hastalarda ortalama sağ ventrikül ejeksiyon fraksiyonu değerinde artış gözlendi; ancak bu istatistiksel olarak anlamlı değildi. Sağ ventrikül alan indeksi, sağ ventrikül hacim indeksi ve triküspid annulus ölçümlerinde ameliyat öncesi değerlere kıyasla azalma tespit edildi. Semptomatik hastalara kıyasla, sağ ventrikül ejeksiyon fraksiyonundaki artış ve sağ ventrikül alan indeksi, sağ ventrikül hacim indeksi ve triküspid annulus değerlerindeki düşüş asemptomatik hastalarda daha az belirgin olmakla birlikte, istatistiksel olarak anlamlı bir fark görülmedi. So nuç:Pulmoner kapak replasmanı düşük mortalite ve morbidite oranları ile yapılabilmektedir. Sağ ventrikül fonksiyonunu iyileştirmek için, ameliyat sağ ventrikül hacminde ve fonksiyonlarında geriye dönüşü olmayan değişiklikler başlamadan önce yapılmalıdır.Anah tarsöz cük ler: Doğuştan kalp hastalığı; pulmoner kapak yetmezliği; pulmoner kapak replasmanı. ABSTRACT Background:In this study, we present our early surgical outcomes of pulmonary valve replacement in patients who underwent right ventricle outflow tract reconstruction.

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Pulmonary Valve Replacement in Tetralogy of Fallot

Cited by 21 publications

References 23 publications

Causes and hemodynamic findings in chronic severe pulmonary regurgitation

Causes and hemodynamic findings in chronic severe pulmonary regurgitation

Computed tomography for evaluating right ventricle and pulmonary artery in pediatric tetralogy of Fallot: correlation with post-operative pulmonary regurgitation

Early surgical outcome of pulmonary valve replacement in patients with previous right ventricle outflow tract reconstruction

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