The change of QRS duration after pulmonary valve replacement in patients with repaired tetralogy of Fallot and pulmonary regurgitation

Abstract

PurposeThis study aimed to analyze changes in QRS duration and cardiothoracic ratio (CTR) following pulmonary valve replacement (PVR) in patients with tetralogy of Fallot (TOF).MethodsChildren and adolescents who had previously undergone total repair for TOF (n=67; median age, 16 years) who required elective PVR for pulmonary regurgitation and/or right ventricular out tract obstruction were included in this study. The QRS duration and CTR were measured pre- and postoperatively and postoperative changes were evaluated.ResultsFollowing PVR, the CTR significantly decreased (pre-PVR 57.2%±6.2%, post-PVR 53.8%±5.5%, P=0.002). The postoperative QRS duration showed a tendency to decrease (pre-PVR 162.7±26.4 msec, post-PVR 156.4±24.4 msec, P=0.124). QRS duration was greater than 180 msec in 6 patients prior to PVR. Of these, 5 patients showed a decrease in QRS duration following PVR; QRS duration was less than 180 msec in 2 patients, and QRS duration remained greater than 180 msec in 3 patients, including 2 patients with diffuse postoperative right ventricular outflow tract hypokinesis. Six patients had coexisting arrhythmias before PVR; 2 patients, atrial tachycardia; 3 patients, premature ventricular contraction; and 1 patient, premature atrial contraction. None of the patients presented with arrhythmia following PVR.ConclusionThe CTR and QRS duration reduced following PVR. However, QRS duration may not decrease below 180 msec after PVR, particularly in patients with right ventricular outflow tract hypokinesis. The CTR and ECG may provide additional clinical information on changes in right ventricular volume and/or pressure in these patients.

Evaluation of electrocardiographic parameters in patients who had lung resections

“…Apart from that, decreased QRS durations, or namely narrow QRS complexes, may be associated with aberrant conduction of supraventricular complexes. This is related to pneumonectomy [13][14][15]. Pmin indicates the minimum P wave duration.…”

Pulmonary Valve Replacement Timing Following Initial Tetralogy of Fallot Repair: A Systematic Review

“…QRS duration, mean pulmonary gradient, and the mean RV did not differ much between pre-and post-PVR procedures [17,[24][25][26]. Other studies have found that the QRS decreased significantly following PVR [8,14,27]. Aleligne et al observed that irrelevant of the type of procedure, there was a 6 ms decrease in the QRS duration in patients whose QRS was over 140 ms three years following surgery [27].…”

“…The reasons for PVR following rTOF are severe PR and severe PR with pulmonary stenosis [ 8 ]. There are many indications for why surgery must occur, outlined in Table 1 .…”

“…The actual mean age of surgery had variations but was not as drastic as the time of PVR following ToF repair. Several studies found that the average age of PVR surgery was 12-16 years [ 8 , 26 , 36 ]. However, a most recent study by Romeo et al observed that the mean age of PVR was 28 years [ 28 ].…”