Timing of pulmonary valve replacement after tetralogy of Fallot repair.
Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease. If left untreated, it carries a 33% mortality in the first year of life and a 50% mortality in the first 3 years of life. Since the introduction of the first open-heart repair by Lillehei and Varco in 1954, surgical management of TOF has evolved to be the primary repair during infancy in the majority of patients. Surgical management of TOF results in anatomic and functional abnormalities in the majority of patients, such as chronic pulmonary valve regurgitation and right ventricular (RV) dysfunction. Long-standing chronic pulmonary valve regurgitation can result in RV dilatation and failure, increasing tricuspid regurgitation, impaired exercise performance and supraventricular or ventricular arrhythmias. A timely reoperation may prevent these consequences, with a complete RV-function recovery. This article provides insight into the questions of when to perform a pulmonary valve implantation and in whom.
Pediatric and Adult Congenital Heart Center, IRCCS-Policlinico San Donato, Via Morandi 30, San Donato Milanese 20097, Italy.
Luciane
L
Piazza
Massimo
M
Chessa
Alessandro
A
Giamberti
Claudio Maria
CM
Bussadori
Gianfranco
G
Butera
Diana Gabriela
DG
Negura
Angelo
A
Micheletti
Edward
E
Callus
Mario
M
Carminati
D000328:Adult; D000375:Aging; D018450:Disease Progression; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007223:Infant; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery*; D017410:Practice Guidelines as Topic; D011664:Pulmonary Valve / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D012720:Severity of Illness Index; D013771:Tetralogy of Fallot / Q000534:rehabilitation / Q000601:surgery*; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery