Key result
Pulmonary valve replacement in patients with repaired tetralogy of Fallot significantly reduced cardiothoracic ratio but did not significantly decrease overall QRS duration (162.7 to 156.4 msec, P=0.124).
Why the study?
Does pulmonary valve replacement reduce QRS duration and cardiothoracic ratio in children and adolescents with repaired tetralogy of Fallot?
Observational (n=67)
No
Does pulmonary valve replacement reduce QRS duration and cardiothoracic ratio in children and adolescents with repaired tetralogy of Fallot?
Absolute Event Rate: 156.4% vs 162.7%
p-value: p=0.124
Pulmonary valve replacement in repaired tetralogy of Fallot significantly reduces cardiothoracic ratio and may reduce QRS duration, potentially reflecting improved right ventricular volume and pressure.
PVR was associated with reduced CTR and a QRS trend in repaired TOF; leaves open whether these markers predict outcomes or guide timing.
PURPOSE: This study aimed to analyze changes in QRS duration and cardiothoracic ratio (CTR) following pulmonary valve replacement (PVR) in patients with tetralogy of Fallot (TOF). METHODS: Children and adolescents who had previously undergone total repair for TOF (n=67; median age, 16 years) who required elective PVR for pulmonary regurgitation and/or right ventricular out tract obstruction were included in this study. The QRS duration and CTR were measured pre- and postoperatively and postoperative changes were evaluated. RESULTS: Following PVR, the CTR significantly decreased (pre-PVR 57.2%±6.2%, post-PVR 53.8%±5.5%, P=0.002). The postoperative QRS duration showed a tendency to decrease (pre-PVR 162.7±26.4 msec, post-PVR 156.4±24.4 msec, P=0.124). QRS duration was greater than 180 msec in 6 patients prior to PVR. Of these, 5 patients showed a decrease in QRS duration following PVR; QRS duration was less than 180 msec in 2 patients, and QRS duration remained greater than 180 msec in 3 patients, including 2 patients with diffuse postoperative right ventricular outflow tract hypokinesis. Six patients had coexisting arrhythmias before PVR; 2 patients, atrial tachycardia; 3 patients, premature ventricular contraction; and 1 patient, premature atrial contraction. None of the patients presented with arrhythmia following PVR. CONCLUSION: The CTR and QRS duration reduced following PVR. However, QRS duration may not decrease below 180 msec after PVR, particularly in patients with right ventricular outflow tract hypokinesis. The CTR and ECG may provide additional clinical information on changes in right ventricular volume and/or pressure in these patients.
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Yun et al. (2018) conducted an observational in Repaired tetralogy of Fallot with pulmonary regurgitation (n=67). Pulmonary valve replacement vs. Pre-operative baseline was evaluated on QRS duration (p=0.124). Pulmonary valve replacement in patients with repaired tetralogy of Fallot significantly reduced cardiothoracic ratio but did not significantly decrease overall QRS duration (162.7 to 156.4 msec, P=0.124).
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