title: "Pulmonary valve replacement diminishes the presence of restrictive physiology and reduces atrial volumes": a prospective study in Tetralogy of Fallot patients.
abstract: Pulmonary valve replacement (PVR) reduces right ventricular (RV) volumes in the setting of long-term pulmonary regurgitation after Tetralogy of Fallot (ToF) repair; however, little is known of its effect on RV diastolic function. Right atrial volumes may reflect the burden of RV diastolic dysfunction. The objective of this paper is to evaluate the clinical, echocardiographic, biochemical and cardiac magnetic resonance (CMR) variables, focusing particularly on right atrial response and right ventricular diastolic function prior to and after elective PVR in adult patients with ToF. This prospective study was conducted from January 2009 to April 2013 in consecutive patients > 18 years of age who had undergone ToF repair in childhood and were accepted for elective PVR. Twenty patients (mean age: 35 years; 70% men) agreed to enter the study. PVR was performed with a bioporcine prosthesis. Concomitant RV reduction was performed in all cases when technically possible. Pulmonary end-diastolic forward flow (EDFF) decreased significantly from 5.4 ml/m(2) to 0.3 ml/m(2) (p < 0.00001), and right atrial four-chamber echocardiographic measurements and volumes by 25% (p = 0.0024): mean indexed diastolic/systolic atrial volumes prior to surgery were 43 ml/m(2) (SD+/-4.6)/63 ml/m(2) (SD+/-5.5), and dropped to 33 ml/m(2) (SD+/-3)/46 ml/m(2) (SD+/-2.55) post-surgery. All patients presented right ventricular diastolic and systolic volume reductions, with a mean volume reduction of 35% (p < 0.00001). Right ventricular diastolic dysfunction was common in a population of severely dilated RV patients long term after ToF repair. Right ventricular diastolic parameters improved as did right atrial volumes in keeping with the known reduction in RV volumes, after PVR.
authors.affiliation: Integrated Hospital Vall d'Hebron-Hospital Sant Pau Adult Congenital Heart Disease Unit, Barcelona, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain. Electronic address: tonyapijuan@hotmail.com.
authors.forename: Antonia
authors.initials: A
authors.lastname: Pijuan-Domenech
authors.affiliation: Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Victor
authors.initials: V
authors.lastname: Pineda
authors.affiliation: Department of Cardiovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Castro
authors.affiliation: Department of Cardiovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Sureda-Barbosa
authors.affiliation: Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Aida
authors.initials: A
authors.lastname: Ribera
authors.affiliation: Department of Biochemistry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Luz M
authors.initials: LM
authors.lastname: Cruz
authors.affiliation: Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Ferreira-Gonzalez
authors.affiliation: Integrated Hospital Vall d'Hebron-Hospital Sant Pau Adult Congenital Heart Disease Unit, Barcelona, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Dos-Subirà
authors.affiliation: Integrated Hospital Vall d'Hebron-Hospital Sant Pau Adult Congenital Heart Disease Unit, Barcelona, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Subirana-Domènech
authors.affiliation: Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Garcia-Dorado
authors.affiliation: Integrated Hospital Vall d'Hebron-Hospital Sant Pau Adult Congenital Heart Disease Unit, Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Casaldàliga-Ferrer
mesh_terms: D000328:Adult; D002306:Cardiac Volume / Q000502:physiology*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011664:Pulmonary Valve / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013318:Stroke Volume; D013771:Tetralogy of Fallot / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome; D016278:Ventricular Function, Right / Q000502:physiology*
keywords: Adult congenital heart disease; Diastolic dysfunction; Pulmonary valve replacement; Restrictive physiology; Tetralogy of Fallot