Surgical pulmonary valve insertion

Abstract

Pulmonary valve replacement is being performed with increasing frequency in patients with various congenital heart diseases. Chronic pulmonary regurgitation after repair of tetralogy of Fallot is a typical situation that requires pulmonary valve replacement. Chronic pulmonary regurgitation after repair of tetralogy of Fallot can lead to right ventricular dilatation, biventricular dysfunction, heart failure symptoms, arrhythmias, and sudden death. Although pulmonary valve replacement can lead to improvement in functional class and a substantial decrease or normalisation of right ventricular volumes, the optimal timing of pulmonary valve replacement in patients with chronic pulmonary regurgitation is still unknown. There are several options for surgical pulmonary valve replacement. However, no ideal pulmonary valve substitute exists currently and most of the surgically implanted pulmonary valves will eventually require re-replacement. This article will review options and timing of surgical pulmonary valve insertion in patients with chronic pulmonary regurgitation after repair of tetralogy of Fallot.

Factors associated with right ventricular dilatation and dysfunction in patients with chronic pulmonary regurgitation after repair of tetralogy of Fallot: Analysis of magnetic resonance imaging data from 218 patients

“…Maskatia and colleagues 27 found that bilateral and unilateral branch pulmonary artery stenosis was associated with a lesser PR fraction and smaller RV EDVI than those in patients without stenosis, likely owing to the development of restrictive physiology. 7 In contrast, other studies have demonstrated that experimentally induced unilateral branch pulmonary artery stenosis resulted in increased PR, in both humans and a swine model. 28,29 These conflicting results should be interpreted cautiously, because the degree of PR was determined by pulmonary artery compliance and resistance (afterload) proximal or distal to the compliance.…”

“…23 Because a longer interval since repair is a risk factor for RV dilatation, timely PVR before the development of irreversible RV dilatation and dysfunction is of a great clinical concern. 7 What remains to be elucidated in the future, preferably by serial MRI examinations, is the course of RV dilatation and dysfunction. This will be important to assist in refining the optimal timing of PVR, which is still an issue with many controversies.…”

“…3 Pulmonary valve replacement (PVR) has become a common practice to avoid the dreadful sequelae of chronic PR, although this procedure is also not without problems. [4][5][6][7][8] The factors associated with RV dilatation and dysfunction in patients with chronic PR after TOF repair are not completely understood. Understanding these factors could help identify those patients who need more careful follow-up to determine the optimal timing of PVR.…”

Polytetrafluoroethylene Bicuspid Pulmonary Valve Replacement: A 5-Year Experience in 119 Patients With Congenital Heart Disease

“…(Ann Thorac Surg 2016;102:163-9) Ó 2016 by The Society of Thoracic Surgeons P ulmonary valve replacement (PVR) is being performed with increasing frequency in patients with a wide variety of congenital heart diseases and is the most common cardiac operation performed in adults with congenital heart disease [1,2]. Chronic pulmonary regurgitation (PR) after repair of tetralogy of Fallot is a typical situation that requires PVR [3][4][5][6].…”

Early Outcomes of Pulmonary Valve Replacement With the Edwards Inspiris Resilia Pericardial Bioprosthesis

“…5 In the current era, stented aortic bioprostheses remain the pulmonary valve substitute of choice, but data are varied with regard to durability and structural valve degeneration (SVD). 6,7 The absence of a valve specifically designed for PVR and suboptimal outcomes with contemporary bioprosthetic valves have led to off-label use of various aortic valve prostheses. The decision to use a specific prosthesis or valve substitute for PVR is often based on its durability in the aortic position.…”