Timing and technique of pulmonary valve replacement in the patient with tetralogy of Fallot. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2012;15(1):27-33
Date
03/20/2012Pubmed ID
22424505DOI
10.1053/j.pcsu.2012.01.007Scopus ID
2-s2.0-84863340892 (requires institutional sign-in at Scopus site) 43 CitationsAbstract
Residual right ventricular (RV) outflow tract pathology is universal among patients with repaired tetralogy of Fallot, and pulmonary regurgitation (PR) is also commonly present. Although tolerated in early life, by the second decade of life PR is associated with an increased risk of death because of ventricular arrhythmias. Pulmonary valve replacement (PVR) is a safe procedure that will eliminate PR, but timing and indications are evolving. Patients with arrhythmias or prolonged QRS duration are candidates for PVR. Patients with symptomatic exercise intolerance are likely to have improvement in symptoms and quality of life and should be offered PVR. Cardiac magnetic resonance has become an essential component of the management of the patient with tetralogy of Fallot with PR, and has identified the potential for and limitations of RV remodeling following PVR. Among patients with severe RV enlargement, particularly those with diminished RV or left ventricular function, there is an increased risk of adverse events and even asymptomatic patients with severe PR should be considered for PVR. Valve replacement is accomplished with homografts or heterografts, either stented bioprosthetic valves or valved conduits. In a retrospective analysis of the Children's Hospital of Wisconsin experience with PVR, there was no difference in survival or freedom from reintervention between heterografts and homografts.
Author List
Tweddell JS, Simpson P, Li SH, Dunham-Ingle J, Bartz PJ, Earing MG, Pelech ANAuthors
Peter J. Bartz MD Chief, Professor in the Pediatrics department at Medical College of WisconsinPippa M. Simpson PhD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentAdult
Age Factors
Bioprosthesis
Child
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation
Humans
Patient Selection
Pulmonary Valve Insufficiency
Retrospective Studies
Tetralogy of Fallot
Treatment Outcome
Young Adult
