Late pulmonary valve replacement after correction of Fallot's tetralogy.
BACKGROUND
The aim of this study was to investigate necessity and outcome of late pulmonary valve replacement (PVR) after repair of tetralogy of Fallot (TOF).


METHODS
Hospital records from patients operated on for TOF at our institution between 1960 and 2002 were reviewed and patients were interviewed by questionnaires.


RESULTS
Out of 411 long-term survivors after TOF-repair, 47 (11.4 %) patients required reoperation after 13.2 +/- 7.4 years. Preoperative right ventricular (RV) dilatation was present in 36 (76.6 %) patients including 16 (34 %) with impaired RV function. Isolated PVR was performed in 12 patients (25.5 %). Additional procedures were necessary in 35 patients (74.5 %), including closure of residual defects (VSD, n = 11), tricuspid valve replacement (n = 1) and repair (n = 3). Obstructive right ventricular or pulmonary artery lesions (34 patients, 72.3 %) were all surgically addressed. RV pressure decreased from 61.1 +/- 27.7 to 42.9 +/- 13.3 mm Hg (p < 0.01) after PVR. RV size was reduced and RV function improved compared to preoperative values. Early mortality after reoperation was 2.1 % (n = 1) with one patient dying from biventricular failure. There was no late mortality.


CONCLUSIONS
PVR after Fallot repair is frequently required because of progressive RV enlargement with dysfunction. It can be performed with relatively low risk, even in the setting of multiple reoperation. Obstructive lesions (RVOTO, PA stenosis) and residual defects are frequently observed in patients needing late PVR and may play a crucial role in the development of RV failure. Timely valve replacement with repair of all obstructive lesions proximal and distal to the implanted valve is the key to preserving RV function.
Zentrum für Herzchirurgie, Universitätsklinik Erlangen-Nürnberg, Germany. Robert.Cesnjevar@herz.imed.uni-erlangen.de
R
R
Cesnjevar
F
F
Harig
A
A
Raber
T
T
Strecker
T
T
Fischlein
A
A
Koch
M
M
Weyand
S
S
Pfeiffer
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D017079:Exercise Tolerance / Q000502:physiology; D005500:Follow-Up Studies; D005858:Germany; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007223:Infant; D007902:Length of Stay; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D011664:Pulmonary Valve / Q000473:pathology / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000503:physiopathology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D013771:Tetralogy of Fallot / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000503:physiopathology / Q000601:surgery; D017725:Ventricular Pressure / Q000502:physiology