Pulmonary regurgitation after tetralogy of Fallot repair: clinical features, sequelae, and timing of pulmonary valve replacement.
Pulmonary regurgitation following repair of tetralogy of Fallot is a common postoperative sequela associated with progressive right ventricular enlargement, dysfunction, and is an important determinant of late morbidity and mortality. Although pulmonary regurgitation may be well tolerated for many years following surgery, it can be associated with progressive exercise intolerance, heart failure, tachyarrhythmia, and late sudden death. It also often necessitates re-intervention. Identifying the appropriate timing of such intervention could be very challenging given the risk of prosthetic valve degeneration and the increased risk of reoperation. Comprehensive informed and regular assessment of the postoperative patient with tetralogy of Fallot, including evaluation of pulmonary regurgitation, right heart structure and function, is crucial to the optimal care of these patients. Pulmonary valve replacement performed in an experienced tertiary referral center is associated with low operative morbidity and mortality and very good long-term results. Early results of percutaneous pulmonary valve replacement are also promising.
Ammash
Naser M
NM
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA. ammash.naser@mayo.edu
Dearani
Joseph A
JA
Burkhart
Harold M
HM
Connolly
Heidi M
HM
D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology; D001705:Bioprosthesis; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D004452:Echocardiography; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008279:Magnetic Resonance Imaging; D011665:Pulmonary Valve Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D011875:Radionuclide Angiography; D012086:Reoperation; D013771:Tetralogy of Fallot / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018754:Ventricular Dysfunction / Q000209:etiology