Abstract 1942: Pulmonary Valve Replacement Improves Left Ventricular Function in Patients With Prior Right Ventricular Outflow Tract Reconstruction
Background: Adults with previous right ventricular (RV) outflow tract reconstruction for tetralogy of Fallot (TOF) and congenital pulmonic stenosis (PS) develop right ventricular (RV) dilatation and dysfunction due to severe pulmonary valve insufficiency. Subsequent Left ventricular (LV) dysfunction may occur with long-standing RV volume overload and dysfunction. Response of LV dysfunction to pulmonary valve replacement (PVR) has not been described.
Methods: We retrospectively identified patients referred for pulmonary valve replacement and reviewed medication history, pre-operative management, echocardiograms and symptoms. Ejection fractions were documented before and a mean of 3 months after PVR by echocardiography. 88% of patients with LV dysfunction (LVEF < 55%) were on a beta-blocker.
Results: Of 46 consecutive patients referred for pulmonary valve replacement (36 with repaired TOF, 10 with congenital PS post valvectomy), 16 had LV dysfunction (mean age 41 years vs. 30 years in the normal LV function group). 2 patients with advanced LV dysfunction (EF < 20%) were referred for cardiac transplantation. 14 patients with LV dysfunction underwent PVR. Ejection fraction improved from 48.5% ± 5.3% preoperatively to 56.2 ± 9.6% (p = 0.023) postoperatively in the LV dysfunction subset of patients.
Conclusions: Left ventricular dysfunction was associated with older age at referral, which may reflect long-standing RV dilatation due to severe pulmonary valve regurgitation. Replacement of the pulmonary valve improved left ventricular function in the majority of patients. Left ventricular dysfunction should not be considered a contraindication to pulmonary valve replacement.