Remodelling of the right ventricle after early pulmonary valve replacement in children with repaired tetralogy of Fallot: assessment by cardiovascular magnetic resonance

Buechel, Emanuela R. Valsangiacomo; Dave, Hitendu; Kellenberger, Christian J.; Dodge‐Khatami, Ali; Prêtre, René; Berger, Felix; Bauersfeld, Urs

doi:10.1093/eurheartj/ehi581

Cited by 290 publications

(166 citation statements)

References 28 publications

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“…Knirsch et al [6] determined pre-replacement RV end-diastolic volume as 201 ± 47 mL/m 2 , and RVEF as 45 ± 6%, while those values were found as 109 ± 15% and 42 ± 8%, 6 months after replacement. Although the studies in the literature found a statistically significant reduction in end-diastolic volume after replacement, they did not find any change in ejection fraction which reflected global systolic function [2,5,7,8]. In our study, although we found highly significant differences in end-diastolic and end-systolic volumes after replacement, we did not find any significant difference for ejection fraction (Table 1).…”

Section: Discussioncontrasting

confidence: 80%

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Analysis of right ventricle function with strain imaging before and after pulmonary valve replacement

et al. 2016

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Section: Discussioncontrasting

confidence: 80%

“…MRI has been indicated as the gold standard method to measure ejection fraction, and volumes and global systolic functions of both ventricles [2]. Reduced exercise capacity, which is a strong indicator of deterioration of the disease, is weakly correlated with RV performance capacity determined by MRI.…”

Section: Discussionmentioning

confidence: 99%

Analysis of right ventricle function with strain imaging before and after pulmonary valve replacement

et al. 2016

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“…These findings were subsequently confirmed by others. 12,14,23 In addition to volumes, CMR can also provide additional data on ejection fraction of both the RV and LV. In a cross-sectional study, Knauth et al 24 examined 88 patients with repaired TOF by CMR.…”

Section: Cardiac Magnetic Resonance Measurements As An Indication Formentioning

confidence: 99%

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

Tweddell

Simpson

et al. 2012

Seminars in Thoracic and Cardiovascular Surgery: Pediatric Card

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Residual right ventricular (RV) outflow tract pathology is universal among patients with repaired tetralogy of Fallot, and pulmonary regurgitation (PR) is also commonly present. Although tolerated in early life, by the second decade of life PR is associated with an increased risk of death because of ventricular arrhythmias. Pulmonary valve replacement (PVR) is a safe procedure that will eliminate PR, but timing and indications are evolving. Patients with arrhythmias or prolonged QRS duration are candidates for PVR. Patients with symptomatic exercise intolerance are likely to have improvement in symptoms and quality of life and should be offered PVR. Cardiac magnetic resonance has become an essential component of the management of the patient with tetralogy of Fallot with PR, and has identified the potential for and limitations of RV remodeling following PVR. Among patients with severe RV enlargement, particularly those with diminished RV or left ventricular function, there is an increased risk of adverse events and even asymptomatic patients with severe PR should be considered for PVR. Valve replacement is accomplished with homografts or heterografts, either stented bioprosthetic valves or valved conduits. In a retrospective analysis of the Children's Hospital of Wisconsin experience with PVR, there was no difference in survival or freedom from reintervention between heterografts and homografts. Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann 15:27-33

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“…Several groups have recently used CMR to investigate the optimal RV size cutoff values for performance of pulmonary valve replacement [17,18]. We evaluated 22 young patients with severe pulmonary valve regurgitation and RV dilatation after TOF repair, and demonstrated that, if pulmonary valve replacement is performed when the RV enddiastolic volume is larger than 150 mL/m 2 , RV remodelling, i.e.…”

Section: Volume Overloadmentioning

confidence: 99%

“…We evaluated 22 young patients with severe pulmonary valve regurgitation and RV dilatation after TOF repair, and demonstrated that, if pulmonary valve replacement is performed when the RV enddiastolic volume is larger than 150 mL/m 2 , RV remodelling, i.e. a significant reduction of RV volume and mass, can be expected [17] ( fig. 3 and 4).…”

Section: Volume Overloadmentioning

confidence: 99%

The right ventricle in tetralogy of Fallot

Stambach¹,

Valsangiacomo²

2009

Schweiz Ärzteztg

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Surgical repair of tetralogy of Fallot (TOF) may be followed by various conditions and residual findings, early postoperatively or late during follow-up. Most of these conditions affect the right ventricular outflow tract and the pulmonary arteries and thus, indirectly, the right ventricle.This paper discusses the role of the right ventricle during the natural history of repaired TOF. The different imaging methods used to assess the function of the right ventricle in relation to this congenital heart disease are highlighted. Particular attention is focused on the volume overloaded right ventricle, as this condition is nowadays a subject of intense discussion, particularly regarding the appropriate timing for pulmonary valve replacement. The most recent literature on this topic is briefly reviewed. In summary, preservation of right ventricular function and prevention of right ventricular arrhythmias are crucial for these patients' survival and outcome. Key words: right ventricle; tetralogy of Fallot; pulmonary regurgitation IntroductionTetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease, occurring in 0.04-0.08% of all liveborns [1, 2]. The main feature of TOF is a ventricular septum defect with anterior deviation of the outlet septum, leading to infundibular subpulmonary stenosis and placing the aorta in an overriding position; in addition, valvular pulmonary stenosis with possible hypoplasia of the main pulmonary artery and its side branches occurs, together with hypertrophy of the right ventricle (RV) ( fig. 1).Besides closing the ventricular septal defect, surgical repair consists of reconstruction of the right ventricular outflow tract (RVOT). RVOT reconstruction can be performed by various surgical techniques, some resulting in residual RVOT obstruction (commissurotomy) and others completely relieving the obstruction at the price of causing pulmonary regurgitation (transannular patch). Thus the surgical technique used usually determines the postoperative findings and eventually the patients' long-term outcome. However, the surgical technique providing the best outcome for the patients has not yet been defined, and the type of repair is chiefly determined by the personal strategy of the operating surgeon in each individual centre. Surgical repair can be performed during the first months of life, ideally at the age of 3 to 4 months, with low perioperative mortality. Long-term mortality was studied by Nollert et al., who reported a 20-year survival rate of 94% [3]. Nevertheless, the survival curve seems to deteriorate after 25 years post TOF repair [3], and significant residual findings may occur resulting in significant morbidity during follow-up. Similarly, Oechslin et al. reported a cumulative percentage of reinterventions required in TOF patients [4]. The most common indications for reintervention consisted of lesions affecting the (RVOT 75%), including severe pulmonary regurgitation, conduit failure and RVOT obstruction. Due to their anatomical location, all these findings may ev...

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Remodelling of the right ventricle after early pulmonary valve replacement in children with repaired tetralogy of Fallot: assessment by cardiovascular magnetic resonance

Abstract: Prompt RV remodelling, with reduction of RV volume and mass, is observed after performing PVR if the RV end-diastolic volume exceeds 150 mL/m(2). Early PVR may prevent the detrimental complications of severe pulmonary regurgitation.

Cited by 290 publications

References 28 publications

Analysis of right ventricle function with strain imaging before and after pulmonary valve replacement

Analysis of right ventricle function with strain imaging before and after pulmonary valve replacement

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

The right ventricle in tetralogy of Fallot

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