Korean Circ J.  2012 Jan;42(1):1-7. 10.4070/kcj.2012.42.1.1.

Surgical Management of Chronic Pulmonary Regurgitation After Relief of Right Ventricular Outflow Tract Obstruction

• Lee C

• KMID: 2297900
• DOI: http://doi.org/10.4070/kcj.2012.42.1.1

Abstract

Relief of right ventricular (RV) outflow tract obstruction in tetralogy of Fallot or similar physiology often results in pulmonary regurgitation (PR). The resultant chronic volume overload can lead to RV dilatation, biventricular dysfunction, heart failure symptoms, arrhythmias and sudden death. Although pulmonary valve replacement (PVR) can lead to improvement in the functional class and a substantial decrease or normalization of RV volumes, the optimal timing of PVR is not well defined. Benefits of PVR have to be weighed against the risks of this procedure including subsequent reoperation. This article reviews the pathophysiology of chronic PR, evidence-based benefits and risks of PVR, options for valve substitute, and optimal timing of PVR in patients with chronic PR after relief of RV outflow tract obstruction.

Keyword

Magnetic resonance imaging; Pulmonary regurgitation; Surgery; Tetralogy of Fallot

MeSH Terms

Arrhythmias, Cardiac
Death, Sudden
Dilatation
Heart Failure
Humans
Magnetic Resonance Imaging
Pulmonary Valve
Pulmonary Valve Insufficiency
Reoperation
Risk Assessment
Tetralogy of Fallot

Figure

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  Fig. 1 Factors influencing right ventricular (RV) dysfunction and impaired clinical status after TOF repair.8) LV: left ventricular, TOF: tetralogy of Fallot, RBBB: right bundle branch block, RVESVI: right ventricular end-systolic volume index, RVOT: right ventricular outflow tract, VT: ventricular tachycardia.

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  Fig. 2 Correlation between pulmonary regurgitation and right ventricular (RV) end-diastolic volume index in 206 patients with repaired TOF.9) TOF: tetralogy of Fallot.

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  Fig. 3 Relationship between right ventricular (RV) end-systolic volume and RV ejection fraction in 100 patients with repaired TOF.8) TOF: tetralogy of Fallot, RV ES; right ventricular end-systolic, BSA; body surface area.

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  Fig. 4 Durability of bioprosthetic valves in the pulmonary position. A: overall freedom from redo pulmonary valve replacement. B: overall freedom from both prosthetic valve failure and dysfunction. Numbers above the X-axis represent patients remaining at risk.39)

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  Fig. 5 Intraoperative view of completed bicuspid pulmonary valve implantation using a 0.1 mm thickness polytetrafluoroethylene membrane. PV: pulmonary valve.

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