September 23, 2002
View Full PaperMagnetic Resonance Imaging to Assess the Hemodynamic Effects of Pulmonary Valve Replacement in Adults Late After Repair of Tetralogy of Fallot
Key Result
Pulmonary valve replacement in adults late after tetralogy of Fallot repair significantly reduced right ventricular end-diastolic volume from 305 mL to 210 mL (P<0.001).
Study Design
Type
Cohort (n=26)
Structured PICO
Does pulmonary valve replacement improve right ventricular hemodynamics and clinical symptoms in adults late after repair of tetralogy of Fallot?
P
Population
26 adult patients with pulmonary regurgitation late after repair of tetralogy of Fallot, evaluated by MRI at a median of 5.1 months before and 7.4 months after pulmonary valve replacement.
E
Exposure
Pulmonary valve replacement (PVR)
C
Comparator
Pre-operative baseline (before-and-after comparison)
O
Outcome
Right ventricular function and pulmonary regurgitation assessed by cardiac MRI, and clinical improvement by NYHA classificationsurrogate
Pulmonary valve replacement in adults with pulmonary regurgitation late after tetralogy of Fallot repair significantly improves right ventricular volumes, corrected ejection fraction, and clinical symptoms.
Main Result
Absolute Event Rate: 210% vs 305%
p-value: p=<0.001
Abstract
BACKGROUND: Pulmonary regurgitation (PR) late after total correction for tetralogy of Fallot may lead to progressive right ventricular (RV) dilatation and an increased incidence of severe arrhythmias and sudden death. Timing of pulmonary valve replacement (PVR) is subject to discussion, because the effect of PVR on RV function in adults is unclear. In this study, MRI was used to assess the effect of PVR on RV function and PR. Clinical improvement was established by means of the NYHA classification. METHODS AND RESULTS: Twenty-six adult patients were included. Cardiac MRI was performed at a median of 5.1+/-3.4 months before and 7.4+/- 2.4 months after PVR. Mean preoperative PR was 46+/-10% (range, 25% to 64%). After PVR, 20 of 26 patients (77%) showed no residual PR, 5 patients showed mild residual PR, and 1 patient showed moderate PR. RV end-diastolic volume (RV-EDV) decreased from 305+/-87 to 210+/-62 mL (P<0.001), and RV end-systolic volume (RV-ESV) decreased from 181+/-67 to 121+/-58 mL (P<0.001). No significant change was found in RV-EF (42% versus 42%). However, RVEF corrected for regurgitations and shunting increased from 25.2+/-8.0% to 43.3+/-13.7% (P<0.001). Mean validity class improved from 2.0 to 1.3 (P<0.001). CONCLUSIONS: In adult patients with PR and RV dilatation, late after total correction of tetralogy of Fallot, MRI measurements show remarkable hemodynamic improvement of RV function after PVR and improvement of validity. We therefore advocate a less restrictive management concerning PVR in these patients.