Right Ventricular Outflow Tract Enlargement Prior to Pulmonary Valve Replacement is Associated with Poorer Structural and Functional Outcomes, in Adults with Repaired Tetralogy of Fallot - 07/05/14
, Madhusudan Ganigara, MD a, c, Phillip Munoz, MRespMed CRFS a, e, David J. Tanous, PhD a, d, Richard B. Chard, PhD a, d, David S. Celermajer, PhD a, b, Rajesh Puranik, PhD a, bRésumé |
Background |
Pulmonary valve replacement (PVR) is commonly performed late after Tetralogy of Fallot (TOF) repair. We examined the effects of PVR on cardiac structure, function and exercise capacity in adults with repaired TOF.
Methods |
Eighteen adult patients with repaired TOF and severe pulmonary regurgitation (PR) with right ventricular (RV) dilatation requiring PVR for clinical reasons (age; 25±8 years) were recruited to undergo cardiac MRI (1.5T) and cardiopulmonary exercise testing before and 14±3 months after PVR.
Results |
Reduced indexed RV end-diastolic volume (RVEDVi; 186±32mL/m2 pre-op vs 114±20mL/m2 post-op, p<0.001) was observed after PVR. “Normalisation” of RVEDVi (≤108mL/m2) was achieved in only seven of 18 patients. Pre-PVR RVEDVi correlated with post-operative change in RVEDVi (change=−72.1±20.4mL/m2, r=−0.815, p<0.001). Exercise capacity remained high-normal post-PVR (% predicted maximal workload: 93±16% vs 91±12%, p=0.5). Regional RV volumes were assessed; RV outflow tract (RVOT) volumes were compared to the RV muscular corpus. Large pre-PVR RVOT volumes correlated negatively with post-surgical RV ejection fraction, peak VO2 and delta VO2 at anaerobic threshold (p<0.05 for all).
Conclusions |
Normalisation of RV volume is unlikely to be achieved above a pre-PVR RVEDVi of 165mL/m2 or more. In particular, an enlarged RVOT prior to PVR predicts suboptimal structural and functional outcomes.
Le texte complet de cet article est disponible en PDF.Keywords : Tetralogy of Fallot, Pulmonary valve replacement, Adult congenital heart disease, Right ventricular dilatation, Cardiopulmonary exercise test, Cardiac magnetic resonance imaging
Plan
Vol 23 - N° 5
P. 482-488 - mai 2014 Retour au numéro
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