No CrossRef data available.
Article contents
Timing of pulmonary valve replacement: can we use the same volumetric thresholds in repaired tetralogy of Fallot and pulmonary stenosis?
Published online by Cambridge University Press: 02 March 2022
Abstract
The timing of pulmonary valve replacement in patients with pulmonary regurgitation following treatment of pulmonary stenosis is undefined. Although cardiac magnetic resonance-based right ventricular volumes in tetralogy of Fallot patients have been used as a guide in pulmonary stenosis patients, anatomic differences between tetralogy of Fallot and pulmonary stenosis patients complicate their application to pulmonary stenosis patients and could result in late referral for pulmonary valve replacement. We sought to determine if pulmonary stenosis patients referred for pulmonary valve replacement were at greater risk for morbidity or need for tricuspid valve intervention at the time of pulmonary valve replacement. A retrospective cohort study was performed on all adult patients with a diagnosis of pulmonary stenosis or tetralogy of Fallot followed at our centre. Clinical and imaging-based exposures were collected. Pre-specified endpoints included need for concomitant tricuspid valve repair or replacement and pre- and post-pulmonary valve replacement cardiac magnetic resonance-based volumetric measurements. Between 1/1999 and 1/2020, 235 patients underwent pulmonary valve replacement for pulmonary regurgitation (52 with pulmonary stenosis, 183 with tetralogy of Fallot). Pulmonary stenosis patients were more likely to have at least moderate tricuspid regurgitation (p = 0.010), undergo concomitant tricuspid valve intervention (p = 0.003), and require tricuspid valve repair or replacement secondary to annular dilation (p = 0.027) compared to tetralogy of Fallot patients. There was no difference in pre-pulmonary valve replacement right ventricular size between pulmonary stenosis and tetralogy of Fallot patients. These findings suggest that referral for pulmonary valve replacement may be occurring later in the disease course for pulmonary stenosis patients.
- Type
- Original Article
- Information
- Copyright
- © The Author(s), 2022. Published by Cambridge University Press
References
Marelli, AJ, Ionescu-Ittu, R, Mackie, AS, et al. Lifetime prevalence of congenital heart disease in the general population from 2000 to 2010. Circulation 2014; 130: 749–756.CrossRefGoogle ScholarPubMed
Cheatham, JP, Coe, JY, Kugler, JD, Fletcher, SE, Tower, AJ. Successful transcatheter perforation of the atretic pulmonary valve membrane in a newborn using the new Coe radiofrequency end hole catheter. Cathet Cardiovasc Diagn 1998; 45: 162–166.3.0.CO;2-N>CrossRefGoogle Scholar
Geva, T. Repaired tetralogy of Fallot: the roles of cardiovascular magnetic resonance in evaluating pathophysiology and for pulmonary valve replacement decision support. J Cardiovasc Magn Reson 2011; 13: 9.CrossRefGoogle ScholarPubMed
Weinberg, CR, McElhinney, DB. Clinician update: pulmonary valve replacement in tetralogy of Fallot. Circulation 2014; 130: 795–798.CrossRefGoogle Scholar
Therrien, J, Provost, Y, Merchant, N, et al. Optimal timing for pulmonary valve replacement in adults after tetralogy of Fallot repair. Am J Cardiol 2005; 95: 779–782.CrossRefGoogle ScholarPubMed
Oosterhof, T, Van Straten, A, Vliegen, HW. Preoperative thresholds for pulmonary valve replacement in patients with corrected tetralogy of Fallot using cardiovascular magnetic resonance. Circulation 2007; 116: 545–551.CrossRefGoogle ScholarPubMed
Beuchel, ER, Dave, HH, Kellenberger, CJ, et al. Remodeling of the right ventricle after early pulmonary valve replacement in children with repaired tetralogy of Fallot: assessment by cardiovascular magnetic resonance. Eur Heart J 2005; 26: 2721–2727.CrossRefGoogle Scholar
Lee, CL, Kim, YM, Lee, CH, et al. Outcomes of pulmonary valve replacement in 170 patients with chronic pulmonary regurgitation after relief of right ventricular outflow tract obstruction: implications for optimal timing of pulmonary valve replacement. J Am Coll Cardiol 2012; 60: 1005–1014.CrossRefGoogle ScholarPubMed
Earing, MG, Connolly, HM, Dearani, JA, et al. Long-term follow-up of patients after surgical treatment for isolated pulmonary valve stenosis. Mayo Clin Proc 2005; 80: 871–876.CrossRefGoogle ScholarPubMed
Stout, KK, Daniels, CJ, Aboulhosn, JA, et al. 2018 AHA/ACC guideline for the management of adults with congenital heart disease. J Am Coll Cardiol 2019; 73: e81–e192. DOI 10.1016/j.jacc.2018.08.1029.CrossRefGoogle ScholarPubMed
Warnes, CA, Williams, RG, Bashore, TM, et al. ACC/AHA guidelines for the management of adults with congenital heart disease: executive summary. Circulation 2008; 118: 2395–2451.CrossRefGoogle ScholarPubMed
Lewis, MJ, O’Connor, DS, Rozenshtien, A, et al. Usefulness of magnetic resonance imaging to guide referral for pulmonary valve replacement in repaired tetralogy of Fallot. Am J Cardiol 2014; 114: 1406–1411.CrossRefGoogle ScholarPubMed
Bokma, JP, Winter, MM, Oosterhof, T, et al. Severe tricuspid regurgitation is predictive of adverse events in tetralogy of Fallot. Heart 2015; 101: 794–799.CrossRefGoogle ScholarPubMed
Deshaies, C, Trottier, H, Khairy, P, et al. Tricuspid valve intervention following pulmonary valve replacement in adults with congenital heart disease. J Am Coll Cardiol 2020; 75: 1033–1043.CrossRefGoogle ScholarPubMed
Kogon, B, Mori, M, Alsoufi, B, Kanter, K, Oster, M. Leaving moderate tricuspid valve regurgitation alone at the time of pulmonary valve replacement: a worthwhile approach. Ann Thorac Surg 2015; 99: 2117–2123.CrossRefGoogle ScholarPubMed
Gatzoulis, MA, Balaji, S, Webber, SA, et al. Risk factors for arrhythmia and sudden cardiac death after late repair of tetralogy of Fallot: a multicentre study. Lancet 2000; 356: 975–981.CrossRefGoogle ScholarPubMed
Lewis, MJ, Ginns, JN, Ye, S, et al. Postoperative tricuspid regurgitation after adult congenital heart surgery is associated with adverse clinical outcomes. J Thorac Cardiovasc Surg 2016; 151: 46–465.CrossRefGoogle ScholarPubMed