We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Timing of Pulmonary Valve Replacement: How Much Can the Right Ventricle Dilate Before it Looses Its Remodeling Potential?
- Authors
Alvarez-Fuente, M.; Garrido-Lestache, E.; Fernandez-Pineda, L.; Romera, B.; Sánchez, I.; Centella, T.; Abelleira, C.; Villagrá, S.; Tamariz, R.; Barrios, E.; Lamas, M.; Gomez, R.; Cerro, M.
- Abstract
Congenital heart disease patients that develop secondary pulmonary regurgitation require a pulmonary valve replacement (PVR) in their follow-up. The indications for PVR in asymptomatic patients are debated. Most guidelines consider a RV end-diastolic volume (RVEDV) over 150 ml/m as an indication for PVR. We analyzed clinical, echocardiographic and MRI variables of patients that underwent a surgical PVR between September 2006 and February 2013. The included patients were asymptomatic, without pulmonary stenosis and with both pre- and post-surgery MRI. Thirty-five patients (74.3 % males) were included. Mean age at PVR was 25.8 years (SD = 7.18), and weight was 64.5 Kg (SD = 12.03). The main diagnosis was tetralogy of Fallot ( n = 28), pulmonary atresia ( n = 2), primary pulmonary regurgitation ( n = 2) and pulmonary regurgitation after percutaneous treatment ( n = 2). The maximal RVEDV pre-PVR was 267 ml/m, and right ventricular end-systolic volume (RVESV) was 183 ml/m. RV size and function were established by MRI:Patients with a RVEDV under 170 ml/m combined with a RVESV under 90 ml/m had a favorable RV remodeling, defined as RVEDV under 110 ml/m (sensitivity 87.5 %), RVESV under 55 ml/m (sensitivity 100 %) and RVEF over 50 % (sensitivity 100 %). When deciding the optimal PVR timing in asymptomatic patients, both RVEDV and RVESV should be considered. Our results suggest that higher volumes than used in the clinical practice can achieve a good remodeling. Therefore, PVR could be performed later in the follow-up reducing the number of cardiac interventions.
- Subjects
PULMONARY valve; HEART valves; CONGENITAL heart disease; HEART abnormalities; CARDIAC surgery
- Publication
Pediatric Cardiology, 2016, Vol 37, Issue 3, p601
- ISSN
0172-0643
- Publication type
Article
- DOI
10.1007/s00246-015-1320-4