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


CONCLUSIONS
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.
Meijboom
Folkert J
FJ
Department of Cardiology, Sophia Children's Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands. w.tomasouw@erasmusmc.nl
Roos-Hesselink
Jolien W
JW
McGhie
Jackie S
JS
Spitaels
Silja E C
SE
van Domburg
Ron T
RT
Utens
Lisbeth M W J
LM
Simoons
Maarten L
ML
Bogers
Ad J J C
AJ
D000328:Adult; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007223:Infant; D018579:Patient Selection; D011664:Pulmonary Valve; D011665:Pulmonary Valve Insufficiency / Q000209:etiology / Q000601:surgery*; D013771:Tetralogy of Fallot / Q000601:surgery*