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. 2025 Nov;16(6):790-800.
doi: 10.1177/21501351251336234. Epub 2025 May 14.

Evaluation of Residual Right Ventricular Outflow Tract Obstruction After Pulmonary Valve-Sparing Repair of Tetralogy of Fallot: An Echocardiographic Study

Roberta Iacobelli  1 , Priscilla Tifi  1 , Gianluigi Perri  2 , Zaccaria Ricci  3   4 , Gianluca Brancaccio  2 , Laura Ragni  1 , Victoria d'Inzeo  2 , Sergio Filippelli  2 , Matteo Trezzi  2 , Lorenzo Galletti  2
Affiliations

Evaluation of Residual Right Ventricular Outflow Tract Obstruction After Pulmonary Valve-Sparing Repair of Tetralogy of Fallot: An Echocardiographic Study

Roberta Iacobelli et al. World J Pediatr Congenit Heart Surg. 2025 Nov.

Abstract

BackgroundPulmonary valve-sparing repair (PVSR) of Tetralogy of Fallot (TOF) provides good results in selected patients. However, recurrent right ventricular outflow tract obstruction (RVOTO) can occur requiring surgical revision. We sought to evaluate the course of RVOTO after PVSR by serial echocardiographic (ECHO) assessment.MethodsA retrospective analysis was conducted in patients who underwent PVSR of TOF at our institution. Demographic, anatomical, surgical and 2D-ECHO data were collected. The cohort was divided into two groups: no reintervention group (group 1) and reintervention group (group 2).ResultsNinety-one patients were included in this study; 13 patients (14%) required reintervention. Right ventricular outflow tract ECHO peak gradient was significantly higher in group 2 at intraoperative transesophageal ECHO (iTEE) (P = .009), at hospital discharge (P = .021), at six months follow-up (P = .0001) and 12 to 36 months follow-up (P = .0001). A more prevalent subvalvular stenosis was found in group 2 at six months (P = .0011) and 12 to 36 months follow-up (P = .00069). An RVOT ECHO peak gradient of 30 mm Hg at iTEE (P = .025) and discharge (P = .011) was statistically associated with the need for reintervention.ConclusionsRight ventricular outflow tract peak gradient was significantly higher in group 2 than in group 1 at iTEE, discharge and follow-up, with an ECHO peak gradient of 30 mm Hg being predictive of reintervention At follow-up, residual RVOTO was prevalent at the subvalvular level in group 2. This information will be useful in clinical decision-making for TOF patients undergoing pulmonary valve sparing repair.

Keywords: RVOT peak gradient; echocardiography; pulmonary valve sparing repair; tetralogy of fallot.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flowchart of this study cohort. PV sparing, pulmonary valve-sparing; TOF, tetralogy of fallot.
Figure 2.
Figure 2.
(A) T test of intraoperative RVOT echocardiographic (ECHO) peak gradient ± standard error (SE); (B) T test of hospital discharge RVOT ECHO peak gradient ± standard error (SE); (C) T test of six months follow-up RVOT ECHO peak gradient ± standard error (SE); (D) T test of 1 to 3 years (12-36 months) RVOT ECHO peak gradient ± standard error (SE). RVOT, right ventricular outflow tract.
Figure 3.
Figure 3.
Two-way repeated measure ANOVA test. Graph of RVOT peak gradient progression over time. RVOT, right ventricular outflow tract.
Figure 4.
Figure 4.
ROC curve showing sensibility and specificity of intraoperative RVOT echocardiographic peak gradient of 30 mm Hg. RVOT, right ventricular outflow tract.
Figure 5.
Figure 5.
T test of intraoperative RV/LV pressure ratio and RVOT peak gradient (mm Hg) ± standard error (SE). LV, left ventricle; RV, right ventricle; RVOT, right ventricular outflow tract.
Figure 6.
Figure 6.
Freedom from reintervention (Kaplan-Meier curve) with number of patients at risk.
See this image and copyright information in PMC

References

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