Key result
Pulmonary valve replacement in patients with Tetralogy of Fallot allowed for favorable remodeling of ventricular volumes but did not significantly change left ventricular circumferential strain, which was normal at baseline.
Why the study?
Does surgical pulmonary valve replacement preserve left ventricular circumferential strain in patients with Tetralogy of Fallot and significant pulmonary regurgitation?
Observational (n=20)
Does surgical pulmonary valve replacement preserve left ventricular circumferential strain in patients with Tetralogy of Fallot and significant pulmonary regurgitation?
Absolute Event Rate: -20.5% vs -18.3%
p-value: p=0.082
Timely pulmonary valve replacement in Tetralogy of Fallot patients with significant pulmonary regurgitation allows for favorable right ventricular remodeling while preserving normal baseline left ventricular circumferential strain.
PVR supports volume remodeling in TOF without altering normal LV strain; leaves open optimal timing and functional endpoints.
Introduction: Patients with Tetralogy of Fallot (TOF) and pulmonary insufficiency and a dilated right ventricle (RV) may suffer from a reduction in left ventricular (LV) performance. It is not clear whether timely pulmonary valve replacement (PVR) preserves LV mechanics. Methods: Ten TOF patients who underwent PVR were identified from hospital records, and pre- and postoperative CMR images were post-processed with a semi-automatic tissue tracking software. LV circumferential strain, time to peak strain, and torsion were compared before and after PVR. A control group of ten age-matched normal volunteers was assessed as a comparison. Results: LV circumferential strain did not change before versus after PVR (basal -18.3 +/- 3.7 % vs. -20.5 +/- 3 %, p 0.082; mid-ventricular -18.4 +/- 3.6 % vs. -19.1 +/- 2 %, p 0.571; apical -22.7 +/- 5.2 % vs. -22.1 +/- 4 %; p 0.703). There was also no difference seen between the baseline strain and normal controls (control basal -18.2 +/- 3.3 %, p 0.937; mid -18 +/- 3.2 %, p 0.798; apex -24.1 +/- 5 %, p 0.552). LV torsion remained unchanged from baseline to post PVR (systolic 2.75 (1.23 – 9.51) °/cm vs. 2.3 +/- 1.2 °/cm, p 0.285; maximum 5.5 +/- 3.5 °/cm vs. 2.34 (1.37 – 8.07) °/cm, p 0.083). There was no difference in time to measured peak LV circumferential strain before versus after PVR (basal 0.44 +/- 0.1 vs. 0.43 +/- 0.05, p 0.912; mid-ventricular 0.42 +/- 0.08 vs. 0.38 +/- 0.06, p 0.186; apical 0.40 +/- 0.08 vs. 0.40 +/- 0.06, p 0.995). At the same time, pulmonary regurgitation and RV end-diastolic and end-systolic volume indices decreased and LV end-diastolic volume increased after PVR. RV and LV ejection fractions remained constant. Conclusion: PVR allows for favorable remodeling of both ventricular volumes for TOF patients with significant pulmonary regurgitation. In this cohort, LV myocardial functional parameters such as circumferential strain, time to peak strain, and LV torsion were normal at baseline and remain unchanged after PVR.
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Burkhardt et al. (2017) conducted an observational in Tetralogy of Fallot (n=20). Pulmonary valve replacement vs. Baseline (pre-PVR) was evaluated on Basal left ventricular circumferential strain (p=0.082). Pulmonary valve replacement in patients with Tetralogy of Fallot allowed for favorable remodeling of ventricular volumes but did not significantly change left ventricular circumferential strain, which was normal at baseline.
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