Right Ventricular Remodeling After Pulmonary Valve Replacement: Early Gains, Late Losses

A propensity score-adjusted analysis of clinical outcomes after pulmonary valve replacement in tetralogy of Fallot

“…These factors may be more important determinants of clinical outcomes in patients with limited RV dilation; (3) surgery is associated with risks4 and may have detrimental short-term impact on RV function 29. Furthermore, myocardial incisions may also create new arrhythmia substrates; and (4) bioprosthetic valves used for PVR typically deteriorate over time,16 which may be associated with progressive RV dilatation and dysfunction,19 with likely multiple reinterventions needed in patients with early referral for PVR as observed in this cohort. Percutaneous PVR may avoid some of these factors, but haemodynamic response is likely similar.…”

Pulmonary valve stenosis in the adult patient: pathophysiology, diagnosis and management

“…Prosthetic pulmonic valve dysfunction and valve durability is limited with the average lifespan estimated to be 10–15 years 35 36. Though the right ventricle initially improves in size, there is evidence of progressive prosthetic pulmonic valve dysfunction and right ventricular deterioration with return to preoperative right ventricular size over the ensuing 10 years 37. Given this and the variability of right ventricular remodelling after restoration of RVOT and pulmonic valve competence, it is difficult to know what criteria clinicians should use to refer for repeat PVR in the absence of symptoms.…”

Tricuspid valve repair and pulmonary valve replacement in adults with repaired tetralogy of Fallot

“…[3][4][5] A recent study highlighted the fact that early reduction (in the first 2-3 postoperative years after PVR) in RV size, progressively deteriorates at 7 to Congenital: Tetralogy of Fallot 10 years post-PVR, leading to reverse remodeling and worsened RV function. 13 This secondary deterioration has been inherent mostly to a subsequent progressive bioprosthetic pulmonary valve dysfunction, but some has been attributed to a TR. 13 This finding corroborates the fact that TR itself may play a role in the development of RV failure.…”