Published Online
on July 9, 2007

A more recent version of this article appeared on July 31, 2007

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Submitted on August 25, 2006
Accepted on May 21, 2007

Preoperative Thresholds for Pulmonary Valve Replacement in Patients With Corrected Tetralogy of Fallot Using Cardiovascular Magnetic Resonance

Thomas Oosterhof MD, PhD, Alexander van Straten MD, Hubert W. Vliegen MD, PhD, Folkert J. Meijboom MD, PhD, Arie P.J. van Dijk MD, PhD, Anje M. Spijkerboer MD, PhD, Berto J. Bouma MD, PhD, Aeilko H. Zwinderman PhD, Mark G. Hazekamp MD, PhD, Albert de Roos MD, PhD, and Barbara J.M. Mulder MD, PhD^*

From the Departments of Cardiology (T.O., B.J.B., B.J.M.M.), Radiology (A.S.), and Clinical Epidemiology and Biostatistics (A.H.Z.), Academic Medical Center, Amsterdam; Departments of Radiology (A.v.S., A.d.R.), Cardiology (H.W.V.), and Cardiothoracic Surgery (M.G.H.), Leiden University Medical Center; Department of Cardiology (F.J.M.), Erasmus Medical Center; Department of Cardiology (A.P.J.v.D.), St Radboud Medical Center, Nijmegen; and Department of Cardiology (B.J.M.M.), University Medical Center, Utrecht, the Netherlands.

^* To whom correspondence should be addressed. E-mail: b.j.mulder{at}amc.uva.nl.

Background--To facilitate the optimal timing of pulmonary valve replacement, we analyzed preoperative thresholds of right ventricular (RV) volumes above which no decrease or normalization of RV size takes place after surgery.

Methods and Results--Between 1993 and 2006, 71 adult patients with corrected tetralogy of Fallot underwent pulmonary valve replacement in a nationwide, prospective follow-up study. Patients were evaluated with cardiovascular magnetic resonance both preoperatively and postoperatively. Changes in RV volumes were expressed as relative change from baseline. RV volumes decreased with a mean of 28%. RV ejection fraction did not change significantly after surgery (from 42±10% to 43±10%; P=0.34). Concomitant RV outflow tract reduction resulted in a 25% larger decrease of RV volumes. After correction for surgical RV outflow tract reduction, higher preoperative RV volumes (mL/m²) were independently associated with a larger decrease of RV volumes (RV end-diastolic volume: =0.41; P<0.001). Receiver operating characteristic analysis revealed a cutoff value of 160 mL/m² for normalization of RV end-diastolic volume or 82 mL/m² for RV end-systolic volume.

Conclusions--Overall, we could not find a threshold above which RV volumes did not decrease after surgery. Preoperative RV volumes were independently associated with RV remodeling and also when corrected for a surgical reduction of the RV outflow tract. However, normalization could be achieved when preoperative RV end-diastolic volume was <160 mL/m² or RV end-systolic volume was <82 mL/m².

Key words: magnetic resonance imaging • surgery • tetralogy of Fallot • pulmonary valve

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Circulation 2007 116: 457. [Extract] [Full Text]

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