Improved right ventricular function following late pulmonary valve replacement for residual pulmonary insufficiency or stenosis

Transcatheter pulmonary valve implantation using the edwards SAPIEN™ transcatheter heart valve

“…The procedure was approved by the Therapeutic Products Directorate, Department of Health and Welfare (Canada), and the United States Food and Drug Administration for compassionate clinical use in patients at high risk for surgery. Patients were considered for TPVI if they had congenital heart disease that had been surgically corrected with the use of a right ventricular outflow tract (RVOT) conduit, and evidence of conduit dysfunction as manifested by symptoms or conventional indications for surgical conduit revision [28–35]. Indications included right ventricular hypertension (>75% of systemic) due to conduit obstruction, significant pulmonary regurgitation (PR), and/or increased right ventricle end diastolic volume (>150 ml/m 2 ).…”

Tetralogy of Fallot: Impact of the Excursion of the Interventricular Septum on Left Ventricular Systolic Function and Fibrosis after Surgical Repair

“…The results of the current study suggest that reduction of RV dilation and volume overload may prevent adverse interventricular interaction and subsequent LV dysfunction and fi brosis in patients after repair of TOF. Since pulmonary valve replacement among patients with hemodynamic relevant residual pulmonary valve regurgitation has been shown to positively infl uence RV size and volume overload, an appropriate timing of pulmonary valve replacement may also positively infl uence LV systolic function (25)(26)(27)(28)(29)(30).…”

Pulmonary Regurgitation after Tetralogy of Fallot Repair: Clinical Features, Sequelae, and Timing of Pulmonary Valve Replacement

“…Several studies reporting on patients who underwent PV replacement for PR in TOF have demonstrated improvement in the functional class, increased exercise tolerance, reduction in RV end diastolic diameter and volume, and at times, improvement in ejection fraction using echocardiography or CMR. 12,14,25,55,57,62,66,71,72 Bove et al 71 were the first to demonstrate that RV dysfunction associated with PR is reversible and that PV replacement should be carried out before permanent RV dysfunction ensues. An increase of more than 5% in RV ejection fraction was noted in 7 patients.…”