title: Should Tricuspid Annuloplasty be Performed With Pulmonary Valve Replacement for Pulmonary Regurgitation in Repaired Tetralogy of Fallot?
abstract: Indications for prophylactic tricuspid annuloplasty in patients with pulmonary regurgitation (PR) after tetralogy of Fallot (TOF) repair are unclear and often extrapolated from acquired functional tricuspid regurgitation (TR) data in adults, where despite correction of primary left heart pathology, progressive tricuspid annular dilation is noted beyond a threshold diameter >4 cm (21 mm/m(2)). We hypothesized that unlike in adult functional TR, in pure volume-overload conditions such as patients with PR after TOF, the tricuspid valve size is likely to regress after pulmonary valve replacement (PVR). A total of 43 consecutive patients who underwent PVR from 2005 until 2012 at a single institution were retrospectively reviewed. Absolute and indexed tricuspid annulus diameters (TADs), tricuspid annulus Z-scores, grade of TR along with right ventricular size, and function indices were recorded before and after PVR. Preoperative and postoperative echocardiographic data were available in all patients. A higher tricuspid valve Z-score correlated with greater TR both preoperatively (P = 0.005) and postoperatively (P = 0.02). Overall reductions in the absolute and indexed TAD and tricuspid valve Z-scores were seen postoperatively, with greater absolute as well as percentage reduction seen with larger preoperative TAD index (P = 0.007) and higher tricuspid annulus Z-scores (P = 0.06). In pure volume-overload conditions such as patients with PR after TOF, reduction in the tricuspid valve size is seen after PVR. Concomitant tricuspid annuloplasty should not be considered based on tricuspid annular dilation alone.
authors.affiliation: Department of Cardiovascular Surgery, Children's National Health System, Washington, District of Columbia.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Kurkluoglu
authors.affiliation: Department of Cardiology, Children's National Health System, Washington, District of Columbia.
authors.forename: Anitha S
authors.initials: AS
authors.lastname: John
authors.affiliation: Department of Cardiology, Children's National Health System, Washington, District of Columbia.
authors.forename: Russell
authors.initials: R
authors.lastname: Cross
authors.affiliation: Department of Cardiovascular Surgery, Children's National Health System, Washington, District of Columbia.
authors.forename: David
authors.initials: D
authors.lastname: Chung
authors.affiliation: Department of Cardiovascular Surgery, Children's National Health System, Washington, District of Columbia.
authors.forename: Can
authors.initials: C
authors.lastname: Yerebakan
authors.affiliation: Department of Anesthesia, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Department of Cardiovascular Surgery, Children's National Health System, Washington, District of Columbia.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Jonas
authors.affiliation: Department of Cardiovascular Surgery, Children's National Health System, Washington, District of Columbia. Electronic address: psinha@childrensnational.org.
authors.forename: Pranava
authors.initials: P
authors.lastname: Sinha
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D058385:Cardiac Valve Annuloplasty; D004219:District of Columbia; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013771:Tetralogy of Fallot / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*; D014463:Ultrasonography; D055815:Young Adult
keywords: CHD; pulmonary valve; tetralogy of Fallot; tricuspid valve