Pulmonary valve replacement in adults late after repair of tetralogy of Fallot: Are we operating too late?

OBJECTIVES The purpose of this study is to evaluate right ventricular (RV) volume and function after pulmonary valve replacement (PVR) and to address the issue of optimal surgical timing in these patients. BACKGROUND Chronic pulmonary regurgitation (PR) following repair of tetralo gy of Fallot (TOF) leads to RV dilation and an increased incidence of sudde n cardiac death in adult patients. METHODS We studied 25 consecutive adult patients who underwent PVR for sign ificant PR late after repair of TOF. Radionuclide angiography was performed in all at a mean of 8.2 months (+/- 8 months) before PVR and repeated at a mean of 28.0 months (+/- 22.8 months) after the operation. Right ventricul ar (RV) end-systolic volume (RVESV), RV end-diastolic volume (RVEDV) and RV ejection fraction (RVEF) were measured. RESULTS Mean RVEDV, RVESV and RVEF remained unchanged after PVR (227.1 ml v ersus 214.9 ml, p = 0.74; 157.4 ml versus 155.3 ml, p = 0.94; 35.6% versus 34.7%, p = 0.78, respectively). Of the 10 patients with RVEF greater than o r equal to 0.40 before PVR, 5 patients (50%) maintained a RVEF greater than or equal to 0.40 following PVR, whereas only 2 out of 15 patients (13%) wi th pre-operative values <0.40 reached an RVEF <greater than or equal to> 0. 40 postoperatively (p < 0.001). CONCLUSIONS Right ventricular recovery following PVR for chronic significan t pulmonary regurgitation after repair of TOF may be compromised in the adu lt population. In order to maintain adequate RV contractility, pulmonary va lve implant in these patients should be considered before RV function deter iorates. (C) 2000 by the American College of Cardiology.