Abstract
Background: Adverse ventricular-ventricular interactions have been recognized in those with repaired tetralogy of Fallot (TOF) and severe pulmonary regurgitation.
Objective: We aimed to examine the impact of pulmonary valve replacement (PVR) on the left heart late after TOF repair.
Methods and results: Left ventricular (LV) volumes and ejection fractions (EF) were analyzed in adults with severe pulmonary regurgitation after TOF repair with cardiac magnetic resonance imaging (CMR) before and after PVR. Thirty-nine patients (median age 33[20–65] years) were reviewed. Post-PVR, LVEF improved significantly in the entire cohort (50±9%→54±7%, p<0.001) and in those with moderately impaired (defined as LVEF ≤45%) preoperative LVEF (38±5%→47±6%, p<0.0001), but was not statistically different in those with relatively preserved (defined as LVEF >45%) preoperative LVEF. By multivariate linear regression analysis to evaluate independent CMR predictors of improved LVEF post-PVR for the entire cohort, the only CMR variable to emerge was preoperative LVEF (p=0.012, regression coefficient −0.54, SE 0.13). Whereas PVR resulted in increased LV filling in patients with relatively preserved preoperative LVEF reflected by an increase in LV end-diastolic volumes (77±10→82±16mL/m2, p=0.05), LV end-systolic volumes decreased after PVR in patients with impaired preoperative LVEF (65±12→54±10mL/m2, p=0.001) but LV end-diastolic volumes were not significantly changed.
Conclusion: When LVEF is decreased after TOF repair, PVR appears to have a salutary effect on postoperative LVEF, thereby supporting the concept of recovery of adverse right–left heart interactions. Mechanisms of left heart improvement post-PVR differ depending on degree of preoperative LV systolic dysfunction.
Objective: We aimed to examine the impact of pulmonary valve replacement (PVR) on the left heart late after TOF repair.
Methods and results: Left ventricular (LV) volumes and ejection fractions (EF) were analyzed in adults with severe pulmonary regurgitation after TOF repair with cardiac magnetic resonance imaging (CMR) before and after PVR. Thirty-nine patients (median age 33[20–65] years) were reviewed. Post-PVR, LVEF improved significantly in the entire cohort (50±9%→54±7%, p<0.001) and in those with moderately impaired (defined as LVEF ≤45%) preoperative LVEF (38±5%→47±6%, p<0.0001), but was not statistically different in those with relatively preserved (defined as LVEF >45%) preoperative LVEF. By multivariate linear regression analysis to evaluate independent CMR predictors of improved LVEF post-PVR for the entire cohort, the only CMR variable to emerge was preoperative LVEF (p=0.012, regression coefficient −0.54, SE 0.13). Whereas PVR resulted in increased LV filling in patients with relatively preserved preoperative LVEF reflected by an increase in LV end-diastolic volumes (77±10→82±16mL/m2, p=0.05), LV end-systolic volumes decreased after PVR in patients with impaired preoperative LVEF (65±12→54±10mL/m2, p=0.001) but LV end-diastolic volumes were not significantly changed.
Conclusion: When LVEF is decreased after TOF repair, PVR appears to have a salutary effect on postoperative LVEF, thereby supporting the concept of recovery of adverse right–left heart interactions. Mechanisms of left heart improvement post-PVR differ depending on degree of preoperative LV systolic dysfunction.
| Original language | English |
|---|---|
| Pages (from-to) | 165-170 |
| Number of pages | 6 |
| Journal | International Journal of Cardiology |
| Volume | 160 |
| Issue number | 3 |
| Early online date | 16 May 2011 |
| DOIs | |
| Publication status | Published - 18 Oct 2012 |
Keywords
- adult congenital heart disease
- tetralogy of Fallot
- magnetic resonance imaging
