Meta-Analysis of Pulmonary Valve Replacement After Operative Repair of Tetralogy of Fallot

Management of right ventricular outfl ow tract obstruction: Evolution to revolution

“…(24) In a meta-analysis of adult and paediatric studies, Cheung observed that none of the studies reported complete normalisation of the RVEDV. (32) They also noticed that In summary, waiting for symptoms to appear before revalvulation is considered, will not lead to reversibility of right ventricular dysfunction. In a recent editorial Geva points out that our ability to prognosticate in these patients at present is poor and propose more liberal indications for PVR.…”

Timing and Technique of Pulmonary Valve Replacement in the Patient With Tetralogy of Fallot

“…[10][11][12][13] In general, PVR results in a modest reduction of QRS duration. 14 In a study by Van Huysduynen et al, 15 26 patients underwent PVR and the average QRS duration decreased from 151 Ϯ 30 ms to 144 Ϯ 29 ms early (6 to 12 months). The decrease in QRS duration correlated with the decrease in RV end-diastolic volume measured by MRI.…”

“…These findings were subsequently confirmed by others. 12,14,23 In addition to volumes, CMR can also provide additional data on ejection fraction of both the RV and LV. In a cross-sectional study, Knauth et al 24 examined 88 patients with repaired TOF by CMR.…”

“…The Society of Thoracic Surgeons Congenital Heart Database includes 1,326 PVRs and 1,402 operations to replace a RV-to-pulmonary artery conduit over the last 4 years, with hospital mortality of 0.7% and 1.0%, respectively. 31 Cheung and colleagues 14 performed a meta-analysis of studies reporting outcome of PVR after TOF repair and summarized the outcome of 15 studies including 595 patients. The pooled early mortality was 2.1% (1.1% to 4%).…”

Blood flow specific assessment of ventricular function: Visualization and quantification using 4D flow CMR

“…Pulmonary valve replacement (PVR) is generally associated with low risks, and survival is excellent (80). As the pulmonary valve prostheses have a limited lifespan, the timing of PVR is still discussed in the light of potential need for additional reoperations in these patients (78,84,85,(87)(88)(89). Patients with signs of RV failure and significant PR will be candidates for reoperation, however it has been suggested that surgery should be performed in asymptomatic patients before irreversible RV remodeling and dysfunction occur (87,90).…”