Preoperative RV end-diastolic volume <147 ml/m2 identified patients with a shorter time to valve replacement (11.0 vs 30.1 years; P=0.03) who showed predictable intraoperative functional recovery.
Observational (n=12)
Does the timing of pulmonary valve replacement based on preoperative RV end-diastolic volume affect early intraoperative functional recovery in patients with repaired tetralogy of Fallot?
Intraoperative video kinematic evaluation suggests that functional recovery after pulmonary valve replacement in tetralogy of Fallot is more predictable when performed before RV end-diastolic volume exceeds 147 ml/m2.
OBJECTIVES: Indications for and timing of pulmonary valve replacement (PVR) after tetralogy of Fallot repair are controversial. Among magnetic resonance imaging indices proposed to time valve replacement, a right ventricular (RV) end-diastolic volume index greater than 160 ml/m2 is often used. Recent evidence suggests that this value may still identify patients with irreversible RV dysfunction, thus hindering recovery. Our goal was to define, using intraoperative video kinematic evaluation, whether a relationship exists between timing of PVR and early functional recovery after surgery. METHODS: Between November 2016 and November 2018, a total of 12 consecutive patients aged 27.1 ± 19.1 years underwent PVR on average 22.2 ± 13.3 years after tetralogy of Fallot repair. Mean RV end-diastolic volume evident on the magnetic resonance images was 136.9 ± 35.7 ml/m2. Intraoperative cardiac kinematics were assessed by video kinematic evaluation via a high-speed camera acquiring videos at 200 fps before and after valve replacement. RESULTS: Patients presenting with RV end-diastolic volume 147 ml/m2 showed an unpredictable outcome. CONCLUSIONS: Video kinematic evaluation provides insight into intraoperative RV recovery in patients with tetralogy of Fallot undergoing PVR. Accordingly, functional recovery can be expected in patients with preoperative end-diastolic volume <147 ml/m2.
Rozzi et al. (Mon,) conducted a observational in Tetralogy of Fallot (n=12). Preoperative RV end-diastolic volume <147 ml/m2 vs. Preoperative RV end-diastolic volume >147 ml/m2 was evaluated on Intraoperative RV functional recovery (kinematic parameters). Preoperative RV end-diastolic volume <147 ml/m2 identified patients with a shorter time to valve replacement (11.0 vs 30.1 years; P=0.03) who showed predictable intraoperative functional recovery.