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J Thorac Cardiovasc Surg 2008;135:50-55
© 2008 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Consequences of a selective approach toward pulmonary valve replacement in adult patients with tetralogy of Fallot and pulmonary regurgitation

Folkert J. Meijboom, MD, PhDa,*, Jolien W. Roos-Hesselink, MD, PhDa, Jackie S. McGhiea, Silja E.C. Spitaels, MD, PhDa, Ron T. van Domburg, MS, PhDa, Lisbeth M.W.J. Utens, PhDc, Maarten L. Simoons, MD, PhDa, Ad J.J.C. Bogers, MD, PhDb

a Department of Cardiology, Sophia Children’s Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
b Department of Cardio-Thoracic Surgery of the Thoraxcentre, Sophia Children’s Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
c Department of Child Psychiatry, Sophia Children’s Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands.

Received for publication April 24, 2007; revisions received June 18, 2007; accepted for publication July 5, 2007.

* Address for reprints: Folkert J. Meijboom, MD, PhD, Erasmus MC, Thoraxcentre, Room BA 300, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. (Email: w.tomasouw{at}erasmusmc.nl).

Objective: The aim of the study was to assess the long-term results of a selective policy toward pulmonary valve replacement in adult patients with repaired tetralogy of Fallot and severe pulmonary regurgitation.

Methods: Sixty-seven patients with tetralogy of Fallot were followed up from 15 ± 3 years until 27 ± 3 years after surgery.

Results: Twenty-two patients had mild-to-moderate pulmonary regurgitation. No significant changes occurred in the follow-up period. Of 45 patients with severe pulmonary regurgitation and severe right ventricular dilatation, 28 (62%) remained free of symptoms and did not undergo pulmonary valve replacement. No changes in right ventricular size or exercise capacity were found. In 3 (11%) of 28 patients, QRS duration increased to more than 180 ms. Seventeen patients had symptoms and underwent pulmonary valve replacement: 9 (54%) of 17 patients improved clinically and echocardiographically, and QRS duration shortened postoperatively. Right ventricular dimensions did not regress despite pulmonary valve replacement in 8 patients.

Conclusion: Refraining from pulmonary valve replacement in asymptomatic patients led to no measurable deterioration in 25 (89%) of 28 patients. Referring symptomatic patients for pulmonary valve replacement led to an improvement in 9 (53%) of 17 patients. In 11 (24%) of 45, a selective approach led to questionable or unsatisfactory results.

Abbreviations and Acronyms ECG = electrocardiogram; PR = pulmonary regurgitation; PVR = pulmonary valve replacement; RV = right ventricular; TR = tricuspid regurgitation




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