Right ventricular remodeling after conduit replacement in patients with corrected tetralogy of Fallot - evaluation by ca
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(2019) 14:77
RESEARCH ARTICLE
Open Access
Right ventricular remodeling after conduit replacement in patients with corrected tetralogy of Fallot - evaluation by cardiac magnetic resonance Henrik Guné1, Johan Sjögren1, Marcus Carlsson2, Ronny Gustafsson1, Pia Sjöberg2 and Shahab Nozohoor1*
Abstract Purpose: To evaluate the potential for right ventricular reverse remodelling after pulmonary valve replacement using cardiac magnetic resonance imaging, in adults with corrected tetralogy of Fallot and severe pulmonary insufficiency. Material and methods: Ten patients with previous correction of tetralogy of Fallot with severe pulmonary insufficiency accepted for pulmonary valve replacement were evaluated prospectively with cardiac magnetic resonance imaging preoperatively and re-evaluated 10 ± 5 months postoperatively. Follow up for survival was 100% complete with mean of 37 ± 12 months. Results: The preoperative mean indexed right ventricular end-diastolic volume was reduced from 161 ± 33 ml/m2 to 120 ± 23 ml/m2 postoperatively, p < 0.001. The preoperative mean indexed right ventricular stroke volume was reduced from 72 ± 20 ml/m2 to 50 ± 6 ml/m2 postoperatively, p = 0.002. After pulmonary valve replacement, the right ventricular ejection fraction did not change significantly (46% versus 42%, p = 0.337). Pulmonary insufficiency fraction decreased from 49% ± 11 to 1% ± 1 postoperatively, p < 0.001. Conclusions: Pulmonary valve replacement leads to a favourable early reverse remodelling with a reduction in RV volumes and improved function in all patients regardless of their preoperative indexed right ventricular volume. Keywords: Adult congenital heart disease, Pulmonary valve replacement, Outcome, Right ventricular function
Introduction Tetralogy of Fallot (TOF) is one of the most common forms of cyanotic congenital heart disease. Patients with TOF undergo cardiac surgery in the early years of childhood. Surgical correction is performed with excellent results and early mortality is low [1]. However, cardiac interventions in children are seldom of a curative nature and many patients require corrective procedures, palliative procedures and reoperations reaching adolescence and adulthood [2]. Pulmonary insufficiency (PI) secondary to pulmonary conduit failure is the most common residual finding during mid- to long-term follow-up and the most * Correspondence: [email protected] 1 Department of Cardiothoracic Surgery, Clinical sciences, Lund University, Skane University Hospital, SE-221 85 Lund, Sweden Full list of author information is available at the end of the article
common indication for re-operation [3, 4]. Previously considered a benign lesion, studies show that PI leads to a dilatation of the right ventricle [5] and an impaired right ventricular function [5, 6]. Eventually, PI leads to RV dilatation with poor exercise tolerance [7] and long-term morbidity with potential lethal complications such as arrhythmias and sudden death [8]. The golden standard treatment for PI in patients with corrected TOF is pul
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