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. 2019 Jan 8;8(1):e010689.
doi: 10.1161/JAHA.118.010689.

Whether Pulmonary Valve Replacement in Asymptomatic Patients With Moderate or Severe Regurgitation After Tetralogy of Fallot Repair Is Appropriate: A Case-Control Study

Fengpu He  1 , Zicong Feng  1 , Qiuming Chen  1 , Yiping Jiao  2 , Zhongdong Hua  1 , Hao Zhang  1 , Keming Yang  1 , Kunjing Pang  1 , Minjie Lu  3 , Kai Ma  1 , Sen Zhang  1 , Lei Qi  1 , Guanxi Wang  1 , Shoujun Li  1
Affiliations

Whether Pulmonary Valve Replacement in Asymptomatic Patients With Moderate or Severe Regurgitation After Tetralogy of Fallot Repair Is Appropriate: A Case-Control Study

Fengpu He et al. J Am Heart Assoc. .

Abstract

Background Although right ventricular ( RV ) volume was significantly decreased in symptomatic patients with repaired tetralogy of Fallot ( rTOF ) after pulmonary valve replacement ( PVR ), RV size was still enlarged along with RV dysfunction. Methods and Results A prospective case-control study was conducted in a tertiary hospital; 81 asymptomatic repaired tetralogy of Fallot patients with moderate or severe pulmonary regurgitation were enrolled. The enrolled cohort was divided into 2 groups: PVR group (n=41) and medication group (n=40). Cardiac magnetic resonance, transthoracic echocardiography, and electrocardiography were scheduled after recruitment and 6 months after PVR or recruitment. Adverse events were recorded during follow-up. Three deaths, 1 heart transplantation, 3 PVR s, and 2 symptomatic heart failures in medication group and 1 redo PVR in the PVR group were observed during follow-up. Compared with the medication group, the PVR group had significantly lower adverse events rate ( P=0.023; odds ratio, 0.086; 95% CI, 0.010-0.716), and RV function was significantly improved ( P<0.05). Binary logistic regression analysis identified preoperative RV end-systolic volume index (10-mL/m2 increment, P=0.009; odds ratio, 0.64; 95% CI, 0.457-0.893) was an independent predictor of normalization of RV size after PVR . A preoperative RV end-systolic volume index cut-off value of 120 mL/m2 (area under curve, 0.819; sensitivity, 90.3%; specificity, 70%) was analyzed by receiver operating characteristic curves for normalized RV size after PVR . Conclusions PVR in asymptomatic repaired tetralogy of Fallot patients is appropriate and effective in reducing right ventricular size and preserving right ventricular function. The recommended criterion of RV end-systolic volume index for PVR is 120 mL/m2.

Keywords: asymptomatic; magnetic resonance; pulmonary valve; tetralogy of Fallot.

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Figures

Figure 1
Figure 1
Freedom from adverse events between groups. Patients in the PVR group had a lower adverse events rate (log rank test, P=0.006). PVR indicates pulmonary valve replacement.
Figure 2
Figure 2
Preoperative RV EDVI, RV ESVI, and QRS duration were analyzed by receiver operating characteristic curves for normalized RV size after pulmonary valve replacement. EDVI indicates end‐diastolic volume index; ESVI, end‐systolic volume index; MRI, magnetic resonance imaging; RV, right ventricular.
See this image and copyright information in PMC

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