Pulmonary Valve Replacement in Adult Patients With a Severely Dilated Right Ventricle and Refractory Arrhythmias After Repair of Tetralogy of Fallot
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Key result
Pulmonary valve replacement improved hemodynamics and exercise capacity in adult TOF patients with a severely dilated right ventricle, but did not completely normalize right ventricular volume or resolve arrhythmogenicity.
Why the study?
Does pulmonary valve replacement improve hemodynamics and reduce refractory arrhythmias in adult patients with a severely dilated right ventricle after repair of tetralogy of Fallot?
Population
3 female adults with a severely dilated right ventricle and refractory tachyarrhythmias late after repair of…
Design
Case_series
Follow-up
2.6-3.8 years
Authors
Discussion
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Implication
May support PVR consideration for hemodynamics in symptomatic adult TOF; hypothesis-generating, prospective trials needed before practice change.
Study Design
Type
Case Report (n=3)
Multicenter
No
Structured PICO
Does pulmonary valve replacement improve hemodynamics and reduce refractory arrhythmias in adult patients with a severely dilated right ventricle after repair of tetralogy of Fallot?
P
Population
3 adult female patients with a severely dilated right ventricle and refractory arrhythmias late after repair of tetralogy of Fallot, followed for 2.6 to 3.8 years after pulmonary valve replacement.
I
Intervention
Pulmonary valve replacement (PVR) using porcine or bovine valves, with concomitant procedures (RV aneurysm resection, RA maze) as indicated, and preoperative catheter ablation for atrial tachycardia in 2 patients.
O
Outcome
Changes in hemodynamics (RVEDVI, LVEF, RA pressure, cardiac index, cardiothoracic ratio, BNP, peak VO2) at 1 year after PVR, and clinical course of tachyarrhythmias.surrogate
Pulmonary valve replacement in adult TOF patients with severely dilated right ventricles improves hemodynamics and reduces arrhythmia burden, though it does not completely resolve arrhythmogenicity.
Limitations
- Small sample size of only 3 patients
- Retrospective study design
- Lack of a control group
- Small sample size
- Retrospective design
Cite This Study
Miyazaki et al. (2009) conducted a case report in Tetralogy of Fallot with severely dilated right ventricle and refractory arrhythmias (n=3). Pulmonary valve replacement was evaluated on Hemodynamic parameters and clinical course of arrhythmias. Pulmonary valve replacement improved hemodynamics and exercise capacity in adult TOF patients with a severely dilated right ventricle, but did not completely normalize right ventricular volume or resolve arrhythmogenicity.
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