Abstract 13161: Serial Follow-Up of Clinical Condition and Ventricular Function in Patients After Repair of Tetralogy of Fallot: We Know When to Operate, Do We?
Introduction: Pulmonary valve replacement (PVR) is often considered in patients with pulmonary regurgitation (PR) after tetralogy of Fallot (TOF) repair. Timing of PVR remains controversial, in part because the course of biventricular remodeling after TOF repair is difficult to predict. We aimed to study the course of biventricular size and function in patients after TOF repair in relation to clinical parameters and to identify independent predictors for outcome variables.
Methods: We prospectively included 78 nonPVR patients, age 25 (10-66) years at final follow-up (FU). Biventricular size and function (MRI), peak oxygen uptake (VO2 max.), and QRS duration were assessed at baseline and after 5 years.
Results were compared to those of 52 PVR patients, age 28 (13-51) years, who had these studies in a 5-year interval before and after PVR.
Results: In nonPVR patients, PR and right ventricular (RV) volumes increased during FU (RV enddiastolic volume (EDV) 130 ± 30 ◊ 138 ± 34 ml/m2, p < 0.001); RV ejection fraction (EF) and RV effective stroke volume (effSV) (46 ± 7 ml/m2) remained unchanged. RV mass/volume ratio decreased (0.20 ± 0.04 ◊ 0.19 ± 0.04 g/ml, p = 0.001). RVEDV slope was 1.6 ± 3.0 ml/m2/year. In multivariate analysis, RVeffSV at baseline was an independent predictor of this slope (r = -0.38, p = 0.001). VO2 max. decreased during FU (96 ± 19% ◊ 91 ± 17%, p = 0.013); QRS duration increased. After PVR, PR and RV volumes (EDV 183 ± 39 ◊ 122 ± 280 ml/m2) decreased; RVeffSV (45 ± 9 ml/m2 ◊ 51 ± 8 ml/m2, p<0.001) and LV volumes increased. Biventricular EF and VO2 max. remained unchanged. At FU, RVeffSV and LVEDV were higher, and RVEF was lower in PVR patients than in non-PVR patients; LVEF and VO2 max. were not significantly different.
Conclusion: In nonPVR patients with normal clinical condition and RV size below current cut-off values for PVR, RVEDV increases with 1.6 ± 3.0 ml/m2/year. Despite limited progression in RV size, unfavourable changes occur (decrease in RV mass/volume ratio and VO2 max.; RVeffSV and LVSV at levels below of those after PVR). This may point towards the need for a less conservative approach towards PVR. However, PVR performed at the upper level of current recommendations has favourable effects on RVeffSV and LV filling, suggesting that PVR was not performed too late.
- © 2011 by American Heart Association, Inc.