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Preoperative thresholds for pulmonary valve replacement in patients with corrected tetralogy of Fallot using cardiovascular magnetic resonance.
Circulation. 2007 Jul 31; 116(5):545-51.Circ

Abstract

BACKGROUND

To facilitate the optimal timing of pulmonary valve replacement, we analyzed preoperative thresholds of right ventricular (RV) volumes above which no decrease or normalization of RV size takes place after surgery.

METHODS AND RESULTS

Between 1993 and 2006, 71 adult patients with corrected tetralogy of Fallot underwent pulmonary valve replacement in a nationwide, prospective follow-up study. Patients were evaluated with cardiovascular magnetic resonance both preoperatively and postoperatively. Changes in RV volumes were expressed as relative change from baseline. RV volumes decreased with a mean of 28%. RV ejection fraction did not change significantly after surgery (from 42+/-10% to 43+/-10%; P=0.34). Concomitant RV outflow tract reduction resulted in a 25% larger decrease of RV volumes. After correction for surgical RV outflow tract reduction, higher preoperative RV volumes (mL/m2) were independently associated with a larger decrease of RV volumes (RV end-diastolic volume: beta=0.41; P<0.001). Receiver operating characteristic analysis revealed a cutoff value of 160 mL/m2 for normalization of RV end-diastolic volume or 82 mL/m2 for RV end-systolic volume.

CONCLUSIONS

Overall, we could not find a threshold above which RV volumes did not decrease after surgery. Preoperative RV volumes were independently associated with RV remodeling and also when corrected for a surgical reduction of the RV outflow tract. However, normalization could be achieved when preoperative RV end-diastolic volume was <160 mL/m2 or RV end-systolic volume was <82 mL/m2.

Authors+Show Affiliations

Academic Medical Center, Department of Cardiology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17620511

Citation

Oosterhof, Thomas, et al. "Preoperative Thresholds for Pulmonary Valve Replacement in Patients With Corrected Tetralogy of Fallot Using Cardiovascular Magnetic Resonance." Circulation, vol. 116, no. 5, 2007, pp. 545-51.
Oosterhof T, van Straten A, Vliegen HW, et al. Preoperative thresholds for pulmonary valve replacement in patients with corrected tetralogy of Fallot using cardiovascular magnetic resonance. Circulation. 2007;116(5):545-51.
Oosterhof, T., van Straten, A., Vliegen, H. W., Meijboom, F. J., van Dijk, A. P., Spijkerboer, A. M., Bouma, B. J., Zwinderman, A. H., Hazekamp, M. G., de Roos, A., & Mulder, B. J. (2007). Preoperative thresholds for pulmonary valve replacement in patients with corrected tetralogy of Fallot using cardiovascular magnetic resonance. Circulation, 116(5), 545-51.
Oosterhof T, et al. Preoperative Thresholds for Pulmonary Valve Replacement in Patients With Corrected Tetralogy of Fallot Using Cardiovascular Magnetic Resonance. Circulation. 2007 Jul 31;116(5):545-51. PubMed PMID: 17620511.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preoperative thresholds for pulmonary valve replacement in patients with corrected tetralogy of Fallot using cardiovascular magnetic resonance. AU - Oosterhof,Thomas, AU - van Straten,Alexander, AU - Vliegen,Hubert W, AU - Meijboom,Folkert J, AU - van Dijk,Arie P J, AU - Spijkerboer,Anje M, AU - Bouma,Berto J, AU - Zwinderman,Aeilko H, AU - Hazekamp,Mark G, AU - de Roos,Albert, AU - Mulder,Barbara J M, Y1 - 2007/07/09/ PY - 2007/7/11/pubmed PY - 2007/8/31/medline PY - 2007/7/11/entrez SP - 545 EP - 51 JF - Circulation JO - Circulation VL - 116 IS - 5 N2 - BACKGROUND: To facilitate the optimal timing of pulmonary valve replacement, we analyzed preoperative thresholds of right ventricular (RV) volumes above which no decrease or normalization of RV size takes place after surgery. METHODS AND RESULTS: Between 1993 and 2006, 71 adult patients with corrected tetralogy of Fallot underwent pulmonary valve replacement in a nationwide, prospective follow-up study. Patients were evaluated with cardiovascular magnetic resonance both preoperatively and postoperatively. Changes in RV volumes were expressed as relative change from baseline. RV volumes decreased with a mean of 28%. RV ejection fraction did not change significantly after surgery (from 42+/-10% to 43+/-10%; P=0.34). Concomitant RV outflow tract reduction resulted in a 25% larger decrease of RV volumes. After correction for surgical RV outflow tract reduction, higher preoperative RV volumes (mL/m2) were independently associated with a larger decrease of RV volumes (RV end-diastolic volume: beta=0.41; P<0.001). Receiver operating characteristic analysis revealed a cutoff value of 160 mL/m2 for normalization of RV end-diastolic volume or 82 mL/m2 for RV end-systolic volume. CONCLUSIONS: Overall, we could not find a threshold above which RV volumes did not decrease after surgery. Preoperative RV volumes were independently associated with RV remodeling and also when corrected for a surgical reduction of the RV outflow tract. However, normalization could be achieved when preoperative RV end-diastolic volume was <160 mL/m2 or RV end-systolic volume was <82 mL/m2. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/17620511/Preoperative_thresholds_for_pulmonary_valve_replacement_in_patients_with_corrected_tetralogy_of_Fallot_using_cardiovascular_magnetic_resonance_ L2 - https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.106.659664?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -