Abstract 14325: Adverse Right Ventricular Remodeling Occurs Late After Surgical Pulmonary Valve Replacement
Background: Pulmonary valve replacement (PVR) after tetralogy of Fallot (TOF) repair results in marked decrease in pulmonary regurgitation (PR) and favorable right ventricular (RV) remodeling with reduction in indexed RV end-diastolic and end-systolic volumes (EDVi and ESVi) early after surgery. However, longer-term RV remodeling outcomes have not been evaluated in detail.
Methods: This is a retrospective analysis of cardiac MR (CMR) data from 2002 to 2011 in patients (pts) who underwent PVR following TOF repair or similar physiology and had ≥1 post-PVR CMR. Using linear mixed-effects models, cross sectional analysis was performed at 1 pre-PVR (within 12 mo) and 4 post-PVR time intervals in 103 eligible pts: Pre-PVR (n=92), 0-1 yr (n=48), 1-2 yr (n=38), 2-4 yr (n=44), and 4-10 yr (n=35). Of these pts, 47 had ≥2 (range 2-7) post-PVR CMRs.
Results: Compared with pre-PVR, in the 0-1 yr post-PVR group PR fraction decreased from 49±11% to 3±2% (p<0.001), RV EDVi decreased by 39% (p<0.001), RV ESVi decreased by 33% (p<0.001), RV ejection fraction (EF) decreased from 48±8% to 44±8% (p=0.01), and LV EDVi and EF did not change significantly. RV EDVi, ESVi, and EF remained unchanged through the 4th post-PVR year. However, comparing the 4-10 yr group with the 0-1 and 1-2 yr groups, RVEDVi and RVESVi were significantly increased, and had returned to 75% and 88% of pre-PVR volumes, respectively (Figure). These changes coincided with an increase in PR fraction from 3±2% at 0-1 yr to 14±14% at 4-10 yr (r=0.33, p<0.001). Based on the pts with ≥2 post-PVR CMRs, post-PVR RVEDVi increased linearly at a rate of 2.9 ml/m2/yr (p=0.002), whereas RVESVi increased at an accelerating rate (p= 0.006).
Conclusion: In this cohort of PVR pts, early reduction in RV size showed a gradual return towards preoperative values beginning 4-10 yrs after surgery. The late adverse RV remodeling was associated with an increase in PR and highlights the palliative nature of PVR and importance of continued surveillance.
- © 2012 by American Heart Association, Inc.