Expanding the indications for pulmonary valve replacement after repair of tetralogy of fallot

Warner, K; O’Brien, Patrick K.H; Rhodes, Jonathan; Kaur, Avnit; Robinson, Davida A.; Payne, David A.

doi:10.1016/s0003-4975(03)00748-3

Cited by 104 publications

(75 citation statements)

References 22 publications

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“…When the deleterious effects of pulmonary regurgitation were more fully appreciated circa 2000, asymptomatic patients with pulmonary regurgitation were considered for PVR, including patients with lower or declining peak V . Our data confirm that surgical PVR is a low-risk operation, 10,14,[17][18][19][20][21][22][23][24][25][26][27][28][29][30] despite the fact that symptomatic patients and patients with multiple previous sternotomies were included in our report. All 5 patients who died early, however, died of right heart failure, suggesting that despite our modified, proactive approach for PVR, we still operate too late in some cases.…”

Section: Discussionsupporting

confidence: 86%

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Clinical Outcomes of Surgical Pulmonary Valve Replacement After Repair of Tetralogy of Fallot and Potential Prognostic Value of Preoperative Cardiopulmonary Exercise Testing

et al. 2014

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Section: Discussionsupporting

confidence: 86%

“…o 2 in pulmonary regurgitation. 41,42 Despite improvement in LV filling and cardiac output and a reduction in RV volumes after PVR, 14,28,43 peak V . o 2 has not been found to improve after intervention in our study or in other studies.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Surgical Pulmonary Valve Replacement After Repair of Tetralogy of Fallot and Potential Prognostic Value of Preoperative Cardiopulmonary Exercise Testing

et al. 2014

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“…Again, for those patients who had successful relief of PR, we have shown improvement in LV filling and LV systolic function (EF and CO) after surgery. Interestingly, these improvements in LV function at rest are not mirrored by improvements in maximal exercise capacity, as we 7 and others 24 have previously demonstrated. However, we have now shown for the first time that the submaximal exercise parameter VE/VCO 2 does improve, improvements that are most likely to reflect better lung and peripheral perfusion related to the increased biventricular effective cardiac output.…”

Section: Discussionsupporting

confidence: 63%

Biventricular Response After Pulmonary Valve Replacement for Right Ventricular Outflow Tract Dysfunction

et al. 2008

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Background— The timing of pulmonary valve replacement (PVR) for free pulmonary incompetence in patients with congenital heart disease remains a dilemma for clinicians. We wanted to assess the determinants of improvement after PVR for pulmonary regurgitation over a wide range of patient ages and to use any identified predictors to compare clinical outcomes between patient groups. Methods and Results— Seventy-one patients (mean age 22±11 years; range, 8.5 to 64.9; 72% tetralogy of Fallot) underwent PVR for severe pulmonary regurgitation. New York Heart Association class improved after PVR (median of 2 to 1, P <0.0001). MRI and cardiopulmonary exercise testing were performed before and 1 year after intervention. After PVR, there was a significant reduction in right ventricular volumes (end diastolic volume 142±43 to 91±18, end systolic volume 73±33 to 43±14 mL/m 2 , P <0.0001), whereas left ventricular end diastolic volume increased (66±12 to 73±13 mL/m 2 , P <0.0001). Effective cardiac output significantly increased (right ventricular: 3.0±0.8 to 3.3±0.8 L/min, P =0.013 and left ventricular: 3.0±0.6 to 3.4±0.7 L/min, P <0.0001). On cardiopulmonary exercise testing, ventilatory response to carbon dioxide production at anaerobic threshold improved from 35.9±5.8 to 34.1±6.2 ( P =0.008). Normalization of ventilatory response to carbon dioxide production was most likely to occur when PVR was performed at an age younger than 17.5 years ( P =0.013). Conclusions— A relatively aggressive PVR policy (end diastolic volume <150 mL/m 2 ) leads to normalization of right ventricular volumes, improvement in biventricular function, and submaximal exercise capacity. Normalization of ventilatory response to carbon dioxide production is most likely to occur when surgery is performed at an age ≤17.5 years. This is also associated with a better left ventricular filling and systolic function after surgery.

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“…[11][12][13][14] This included right ventricular (RV) hypertension (two thirds of systemic blood pressure or greater) with outflow tract obstruction, significant pulmonary insufficiency, RV dilatation, or RV failure. Echocardiography was performed on VIVID 7 (GE, Medical Systems, Milwaukee, Wis.) in all patients.…”

Section: Methodsmentioning

confidence: 99%

Percutaneous Pulmonary Valve Implantation in Humans

et al. 2005

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Background-Right ventricular outflow tract (RVOT) reconstruction with valved conduits in infancy and childhood leads to reintervention for pulmonary regurgitation and stenosis in later life. Methods and Results-Patients with pulmonary regurgitation with or without stenosis after repair of congenital heart disease had percutaneous pulmonary valve implantation (PPVI). Mortality, hemodynamic improvement, freedom from explantation, and subjective and objective changes in exercise tolerance were end points. PPVI was performed successfully in 58 patients, 32 male, with a median age of 16 years and median weight of 56 kg. The majority had a variant of tetralogy of Fallot (nϭ36), or transposition of the great arteries, ventricular septal defect with pulmonary stenosis (nϭ8

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Expanding the indications for pulmonary valve replacement after repair of tetralogy of fallot

Cited by 104 publications

References 22 publications

Clinical Outcomes of Surgical Pulmonary Valve Replacement After Repair of Tetralogy of Fallot and Potential Prognostic Value of Preoperative Cardiopulmonary Exercise Testing

Clinical Outcomes of Surgical Pulmonary Valve Replacement After Repair of Tetralogy of Fallot and Potential Prognostic Value of Preoperative Cardiopulmonary Exercise Testing

Biventricular Response After Pulmonary Valve Replacement for Right Ventricular Outflow Tract Dysfunction

Percutaneous Pulmonary Valve Implantation in Humans

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