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Pulmonary valve replacement after tetralogy of Fallot repair in preadolescent patients.
Ann Thorac Surg. 2010 Jan; 89(1):147-51.AT

Abstract

BACKGROUND

After tetralogy of Fallot (TOF) repair, severe pulmonary insufficiency is known to impair biventricular function. Pulmonary valve replacement (PVR) alleviates symptoms, normalizes right ventricular volumes, and improves ventricular function. Most studies addressing the role of PVR have examined older adolescents or adults. Less is known about the potential benefits of PVR in preadolescents with TOF and significant right ventricular dilatation.

METHODS

We reviewed the clinical data for all preadolescents (< or = 13 years) with TOF who underwent cardiac magnetic resonance imaging (cMRI) or PVR, or both. Serial cMRI data were analyzed to determine the change in indexed right ventricular end-diastolic volume (RVEDV) and biventricular ventricular ejection fractions. Available cMRI data after PVR were compared with data before PVR.

RESULTS

During the study period, 101 preadolescents with TOF had cMRI. The median age of complete repair was 6 months (range, 6 days to 3.4 years). The mean RVEDV at the first study was 135 +/- 39 mL/m(2). For 32 with serial cMRI studies, the RVEDV increased at a mean yearly rate of 9 mL/m(2). Ventricular systolic function was impaired in 46 (46%). Forty-two patients underwent PVR at a mean age of 8 +/- 3 years. No hospital deaths occurred, and no pulmonary valve reinterventions have been required.

CONCLUSIONS

Significant right ventricular dilatation is common in preadolescents after transannular patch repair of TOF. Routine follow-up of this population should incorporate cMRI. Further studies will be needed to determine whether a strategy of early PVR might improve intermediate-term outcome.

Authors+Show Affiliations

Sibley Heart Center Cardiology, Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

20103225

Citation

Lindsey, C Wesley, et al. "Pulmonary Valve Replacement After Tetralogy of Fallot Repair in Preadolescent Patients." The Annals of Thoracic Surgery, vol. 89, no. 1, 2010, pp. 147-51.
Lindsey CW, Parks WJ, Kogon BE, et al. Pulmonary valve replacement after tetralogy of Fallot repair in preadolescent patients. Ann Thorac Surg. 2010;89(1):147-51.
Lindsey, C. W., Parks, W. J., Kogon, B. E., Sallee, D., & Mahle, W. T. (2010). Pulmonary valve replacement after tetralogy of Fallot repair in preadolescent patients. The Annals of Thoracic Surgery, 89(1), 147-51. https://doi.org/10.1016/j.athoracsur.2009.07.039
Lindsey CW, et al. Pulmonary Valve Replacement After Tetralogy of Fallot Repair in Preadolescent Patients. Ann Thorac Surg. 2010;89(1):147-51. PubMed PMID: 20103225.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pulmonary valve replacement after tetralogy of Fallot repair in preadolescent patients. AU - Lindsey,C Wesley, AU - Parks,W James, AU - Kogon,Brian E, AU - Sallee,Denver,3rd AU - Mahle,William T, PY - 2009/04/10/received PY - 2009/07/08/revised PY - 2009/07/10/accepted PY - 2010/1/28/entrez PY - 2010/1/28/pubmed PY - 2010/3/5/medline SP - 147 EP - 51 JF - The Annals of thoracic surgery JO - Ann. Thorac. Surg. VL - 89 IS - 1 N2 - BACKGROUND: After tetralogy of Fallot (TOF) repair, severe pulmonary insufficiency is known to impair biventricular function. Pulmonary valve replacement (PVR) alleviates symptoms, normalizes right ventricular volumes, and improves ventricular function. Most studies addressing the role of PVR have examined older adolescents or adults. Less is known about the potential benefits of PVR in preadolescents with TOF and significant right ventricular dilatation. METHODS: We reviewed the clinical data for all preadolescents (< or = 13 years) with TOF who underwent cardiac magnetic resonance imaging (cMRI) or PVR, or both. Serial cMRI data were analyzed to determine the change in indexed right ventricular end-diastolic volume (RVEDV) and biventricular ventricular ejection fractions. Available cMRI data after PVR were compared with data before PVR. RESULTS: During the study period, 101 preadolescents with TOF had cMRI. The median age of complete repair was 6 months (range, 6 days to 3.4 years). The mean RVEDV at the first study was 135 +/- 39 mL/m(2). For 32 with serial cMRI studies, the RVEDV increased at a mean yearly rate of 9 mL/m(2). Ventricular systolic function was impaired in 46 (46%). Forty-two patients underwent PVR at a mean age of 8 +/- 3 years. No hospital deaths occurred, and no pulmonary valve reinterventions have been required. CONCLUSIONS: Significant right ventricular dilatation is common in preadolescents after transannular patch repair of TOF. Routine follow-up of this population should incorporate cMRI. Further studies will be needed to determine whether a strategy of early PVR might improve intermediate-term outcome. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/20103225/Pulmonary_valve_replacement_after_tetralogy_of_Fallot_repair_in_preadolescent_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(09)01518-5 DB - PRIME DP - Unbound Medicine ER -