Abstract 19356: Pulmonary Valve Replacement Can be Delayed in Repaired Tetralogy of Fallot Patients with Preserved RVEF
BACKGROUND Surgical pulmonary valve replacement (PVR) is common in repaired Tetrology of Fallot. PVR is indicated for right ventricle (RV) remodeling. Previous studies have found that RV size normalization is rare in larger RVs that exceed RV end-diastolic volume (RVEDV) 160 mL/m2.
METHODS A retrospective chart review was conducted in patients > 18 years who had PVR at our institution from 2000-2011. Demographic and clinical data, pre and post-operative MRI, and ECG, were collected.
RESULTS 19 patients were included. Average age was 24.9 years (range 18-44y). Average age at PVR was 20.3 years (range 12-40y). Only 2 patients had a pre-operative RVEDV < 160 mL/m2, with one patient whose RVEDV normalized ( 160 mL/m2 normalized RVEDV following PVR. All 4 patients without significant post-operative pulmonary regurgitation and preserved RVEF normalized. All had pre-operative RVEDVs > 160 mL/m2, with three >190 mL/m2. Table 1 shows, overall RV volume and function improved significantly following PVR while QRS duration remained unchanged by paired t-test.
CONCLUSION In contrast to prior studies, delaying PVR in patients with preserved RVEF may be a reasonable management strategy. Our findings suggest that in patients with preserved RVEF, PVR can be delayed until the RVEDV reaches 190mL/m2. In patients with preserved RVEF, PVR with RVEDV < 160 mL/m2 may not be warranted.
- © 2012 by American Heart Association, Inc.