Korean J Pediatr.  2018 Nov;61(11):362-365. 10.3345/kjp.2018.06765.

The change of QRS duration after pulmonary valve replacement in patients with repaired tetralogy of Fallot and pulmonary regurgitation

• Yun Y
• Kim YH
• Kwon JE

• KMID: 2433704
• DOI: http://doi.org/10.3345/kjp.2018.06765

Abstract

PURPOSE
This study aimed to analyze changes in QRS duration and cardiothoracic ratio (CTR) following pulmonary valve replacement (PVR) in patients with tetralogy of Fallot (TOF).
METHODS
Children and adolescents who had previously undergone total repair for TOF (n=67; median age, 16 years) who required elective PVR for pulmonary regurgitation and/or right ventricular out tract obstruction were included in this study. The QRS duration and CTR were measured pre- and postoperatively and postoperative changes were evaluated.
RESULTS
Following PVR, the CTR significantly decreased (pre-PVR 57.2%±6.2%, post-PVR 53.8%±5.5%, P=0.002). The postoperative QRS duration showed a tendency to decrease (pre-PVR 162.7±26.4 msec, post-PVR 156.4±24.4 msec, P=0.124). QRS duration was greater than 180 msec in 6 patients prior to PVR. Of these, 5 patients showed a decrease in QRS duration following PVR; QRS duration was less than 180 msec in 2 patients, and QRS duration remained greater than 180 msec in 3 patients, including 2 patients with diffuse postoperative right ventricular outflow tract hypokinesis. Six patients had coexisting arrhythmias before PVR; 2 patients, atrial tachycardia; 3 patients, premature ventricular contraction; and 1 patient, premature atrial contraction. None of the patients presented with arrhythmia following PVR.
CONCLUSION
The CTR and QRS duration reduced following PVR. However, QRS duration may not decrease below 180 msec after PVR, particularly in patients with right ventricular outflow tract hypokinesis. The CTR and ECG may provide additional clinical information on changes in right ventricular volume and/or pressure in these patients.

Keyword

Tetralogy of Fallot; Heart valve prosthesis implantation; Electrocardiography

MeSH Terms

Adolescent
Arrhythmias, Cardiac
Atrial Premature Complexes
Child
Electrocardiography
Heart Valve Prosthesis Implantation
Humans
Pulmonary Valve Insufficiency*
Pulmonary Valve*
Tachycardia
Tetralogy of Fallot*
Ventricular Premature Complexes