Late pulmonary valve replacement after repair of tetralogy of Fallot

Discigil, Berent; Dearani, Joseph A.; Puga, Francisco J.; Schaff, Hartzell V.; Hagler, Donald J.; Warnes, Carole A.; Danielson, Gordon K.

doi:10.1067/mtc.2001.111209

Cited by 245 publications

(156 citation statements)

References 26 publications

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“…Although pulmonary regurgitation is the main underlying risk factor for ventricular arrhythmia and sudden cardiac death late after repair of TOF, 11) pulmonary valve replacement has been shown to be effective in stabilizing QRS duration, 12) improving right ventricular function, and reducing atrial arrhythmia. 13,14) In order to maintain right ventricular contractility, pulmonary valve replacement has been recommended before right ventricular function deteriorates. 15) Total correction of TOF can be performed safely in adults with low mortality, however, there have been few reports in patients over 60 years of age.…”

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A Critical Increase in Right-to-Left Shunt After Acute Myocardial Infarction in a 68-year-old Male With Tetralogy of Fallot

et al. 2005

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SUMMARYA male patient with tetralogy of Fallot accompanied by aortic regurgitation had maintained sufficient exercise capacity for a number of decades with the status of acyanotic tetralogy of Fallot. When he was 67 years old, he suffered a posterior wall acute myocardial infarction and direct percutaneous coronary angioplasty successfully revascularised the target lesion in the left circumflex artery. However, a few months after the onset of the myocardial infarction, his shortness of breath became clinically significant and was associated with increased right-to-left shunt and increased right ventricular end-diastolic pressure, as well as hypoxia. At 68 years old, therefore, total corrective repair of the tetralogy with replacement of the aortic and pulmonary valves was performed. The patient was asymptomatic after the successful operation. This report suggests that coronary artery disease can be one of the potential factors in inducing critical hemodynamic changes in aging patients with congenital heart disease, especially those who have a shunt between the right and left chambers. The unique clinical course is described with some discussion of the repair of tetralogy in adults. (Int Heart J 2005; 46: 167-174)

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A Critical Increase in Right-to-Left Shunt After Acute Myocardial Infarction in a 68-year-old Male With Tetralogy of Fallot

et al. 2005

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“…[1][2][3] Many centers advocate pulmonary valve replacement for these patients. 4,5 In a recent study, a positive effect of pulmonary valve replacement on right ventricle (RV) contractile function could only be demonstrated in patients with preserved RV function, whereas those with an impaired RV function showed no improvement. 5 The conclusion from this study was that pulmonary valve replacement had been performed too late.…”

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Pulmonary Regurgitation Is an Important Determinant of Right Ventricular Contractile Dysfunction in Patients With Surgically Repaired Tetralogy of Fallot

et al. 2004

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“…[2][3][4][5] In this regard, pulmonary valve replacement has increasingly been recommended. 6 The characteristics of pulmonary regurgitation after repair of TOF have been studied extensively by a variety of methods. [2][3][4][7][8][9][10] However, the contribution of each branch pulmonary artery to total pulmonary regurgitation has not been investigated.…”

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Differential Regurgitation in Branch Pulmonary Arteries After Repair of Tetralogy of Fallot

et al. 2003

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Background-The importance of pulmonary regurgitation (PR) after repair of tetralogy of Fallot (TOF) is increasingly recognized, but little is known regarding its underlying mechanisms. This phase-contrast cine magnetic resonance (PC MR) study was performed to evaluate the relative contribution of each lung to total regurgitant volume. Methods and Results-Twenty-two patients with significant PR underwent a PC MR 3 to 16 years after repair of TOF.Regurgitant fraction of the main pulmonary artery was 39Ϯ10%. Regurgitant fraction of the left pulmonary artery (LPA; 46Ϯ18%) was greater than that of the right pulmonary artery (34Ϯ16%; Pϭ0.002). The average contribution of the LPA to the total regurgitant flow volume was 54Ϯ19%, whereas its average contribution to the total forward flow volume was 44Ϯ13% (Pϭ0.002). In 4 patients, regurgitant flow in the LPA accounted for 75% to 100% of the total regurgitant flow. There was a linear relationship between regurgitant fraction and fraction of the regurgitant flow duration in the main pulmonary artery (PϽ0.001) and right pulmonary artery (Pϭ0.001) but not in the LPA (Pϭ0.129). Conclusions-PR after repair of TOF is commonly associated with differential regurgitation in the branch pulmonary arteries, which is usually greater in the LPA. Although the cause of this disparity requires further investigation, those patients with a significant unilateral contribution to total PR may be amenable to localized techniques to reduce regurgitation. (Circulation. 2003;107:2938-2943.)

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Late pulmonary valve replacement after repair of tetralogy of Fallot

Abstract: Late pulmonary valve replacement after tetralogy repair significantly improves right ventricular function, functional class, and atrial arrhythmias, and it can be performed with low mortality. Subsequent re-replacement may be necessary to maintain functional improvement.

Cited by 245 publications

References 26 publications

A Critical Increase in Right-to-Left Shunt After Acute Myocardial Infarction in a 68-year-old Male With Tetralogy of Fallot

A Critical Increase in Right-to-Left Shunt After Acute Myocardial Infarction in a 68-year-old Male With Tetralogy of Fallot

Pulmonary Regurgitation Is an Important Determinant of Right Ventricular Contractile Dysfunction in Patients With Surgically Repaired Tetralogy of Fallot

Differential Regurgitation in Branch Pulmonary Arteries After Repair of Tetralogy of Fallot

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