title: Left ventricular function improves after pulmonary valve replacement in patients with previous right ventricular outflow tract reconstruction and biventricular dysfunction.
abstract: Congenital heart defects that have a component of right ventricular outflow tract obstruction, such as tetralogy of Fallot, are frequently palliated in childhood by disruption of the pulmonary valve. Although this can provide an initial improvement in quality of life, these patients are often left with severe pulmonary valve insufficiency. Over time, this insufficiency can lead to enlargement of the right ventricle and to the deterioration of right ventricular systolic and diastolic function. Pulmonary valve replacement in these patients decreases right ventricular volume overload and improves right ventricular performance. To date, few studies have examined the effects of pulmonary valve replacement on left ventricular function in patients with biventricular dysfunction. We sought to perform such an evaluation.Records of adult patients who had undergone pulmonary valve replacement from January 2003 through November 2006 were analyzed retrospectively. We reviewed preoperative and postoperative echocardiograms and calculated left ventricular function in 38 patients.In the entire cohort, the mean left ventricular ejection fraction increased by a mean of 0.07 after pulmonary valve replacement, which was a statistically significant change (P < 0.01). In patients with preoperative ejection fractions of less than 0.50, mean ejection fractions increased by 0.10.We conclude that pulmonary valve replacement in patients with biventricular dysfunction arising from severe pulmonary insufficiency and right ventricular enlargement can improve left ventricular function. Prospective studies are needed to verify this finding.
authors: Sibley Heart Center Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia 30341, USA. colin.kane@utsouthwestern.edu
authors: Colin
authors: C
authors: Kane
authors: Brian
authors: B
authors: Kogon
authors: Maria
authors: M
authors: Pernetz
authors: Michael
authors: M
authors: McConnell
authors: Paul
authors: P
authors: Kirshbom
authors: Katherine
authors: K
authors: Rodby
authors: Wendy M
authors: WM
authors: Book
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D017380:Hypertrophy, Right Ventricular / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D013318:Stroke Volume; D013781:Texas; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D055815:Young Adult
chemical_list: D002317:Cardiovascular Agents