Consequences of a selective approach toward pulmonary valve replacement in adult patients with tetralogy of Fallot and pulmonary regurgitation

Meijboom, Folkert J.; Roos-Hesselink, Jolien W.; McGhie, Jackie S.; Spitaels, Silja E.C.; van Domburg, Ron T.; Utens, Lisbeth M.W.J.; Simoons, Maarten L.; Bogers, Ad J.J.C.

doi:10.1016/j.jtcvs.2007.07.030

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 135, Issue 1 , Pages 50-55, January 2008

Consequences of a selective approach toward pulmonary valve replacement in adult patients with tetralogy of Fallot and pulmonary regurgitation

Folkert J. Meijboom, MD, PhD
- Department of Cardiology, Sophia Children’s Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Address for reprints: Folkert J. Meijboom, MD, PhD, Erasmus MC, Thoraxcentre, Room BA 300, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
Jolien W. Roos-Hesselink, MD, PhD
- Department of Cardiology, Sophia Children’s Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
Jackie S. McGhie
- Department of Cardiology, Sophia Children’s Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
Silja E.C. Spitaels, MD, PhD
- Department of Cardiology, Sophia Children’s Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
Ron T. van Domburg, MS, PhD
- Department of Cardiology, Sophia Children’s Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
Lisbeth M.W.J. Utens, PhD
- Department of Child Psychiatry, Sophia Children’s Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Maarten L. Simoons, MD, PhD
- Department of Cardiology, Sophia Children’s Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
Ad J.J.C. Bogers, MD, PhD
- Department of Cardio-Thoracic Surgery of the Thoraxcentre, Sophia Children’s Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands

Received 24 April 2007; received in revised form 18 June 2007; accepted 5 July 2007.

Objective

The aim of the study was to assess the long-term results of a selective policy toward pulmonary valve replacement in adult patients with repaired tetralogy of Fallot and severe pulmonary regurgitation.

Methods

Sixty-seven patients with tetralogy of Fallot were followed up from 15 ± 3 years until 27 ± 3 years after surgery.

Results

Twenty-two patients had mild-to-moderate pulmonary regurgitation. No significant changes occurred in the follow-up period. Of 45 patients with severe pulmonary regurgitation and severe right ventricular dilatation, 28 (62%) remained free of symptoms and did not undergo pulmonary valve replacement. No changes in right ventricular size or exercise capacity were found. In 3 (11%) of 28 patients, QRS duration increased to more than 180 ms. Seventeen patients had symptoms and underwent pulmonary valve replacement: 9 (54%) of 17 patients improved clinically and echocardiographically, and QRS duration shortened postoperatively. Right ventricular dimensions did not regress despite pulmonary valve replacement in 8 patients.

Conclusion

Refraining from pulmonary valve replacement in asymptomatic patients led to no measurable deterioration in 25 (89%) of 28 patients. Referring symptomatic patients for pulmonary valve replacement led to an improvement in 9 (53%) of 17 patients. In 11 (24%) of 45, a selective approach led to questionable or unsatisfactory results.

CTSNet classification: 21, 35

Abbreviations and Acronyms: ECG, electrocardiogram, PR, pulmonary regurgitation, PVR, pulmonary valve replacement, RV, right ventricular, TR, tricuspid regurgitation