Remodelling of the right ventricle after early pulmonary valve replacement in children with repaired tetralogy of Fallot: assessment by cardiovascular magnetic resonance

Abstract

Aims: Correct timing of pulmonary valve replacement (PVR) is crucial for preventing complications of pulmonary regurgitation and right ventricular (RV) dilatation after repair of tetralogy of Fallot. We sought to assess the remodelling of the RV after early PVR in children, using cardiovascular magnetic resonance (CMR).

Methods and results: Twenty children with severe pulmonary regurgitation and RV dilatation and mean age 13.9 +/- 3 years underwent CMR evaluation 5.6 +/- 1.8 months before and 5.9 +/- 0.6 months after PVR. PVR was performed when the RV end-diastolic volume exceeded 150 mL/m(2), as measured by CMR. The time interval between primary repair and PVR was 12 +/- 3 years. Post-operative CMR demonstrated a significant reduction of the RV end-diastolic volume from 189.8 +/- 33.4 to 108.7 +/- 25.8 mL/m(2) (P < 0.0001), of the RV end-systolic volume from 102.4 +/- 27.3 to 58.2 +/- 16.3 mL/m(2) (P < 0.0001), and of the RV mass from 48.7 +/- 12.3 to 35.8 +/- 7.7 g/m(2) (P < 0.0001). The RV ejection fraction did not change significantly.

Conclusion: Prompt RV remodelling, with reduction of RV volume and mass, is observed after performing PVR if the RV end-diastolic volume exceeds 150 mL/m(2). Early PVR may prevent the detrimental complications of severe pulmonary regurgitation.