RV STRAIN COMPARISONS BETWEEN REPAIRED TETRALOGY OF FALLOT AND ISOLATED PULMONARY REGURGITATION
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Pulmonary valve
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: Pulmonary regurgitation is the most important sequellae after correction of Tetralogy of Fallot and has a considerable impact over the right ventricle. Surgery has demonstrated low early mortality after pulmonary valve replacement and good long-term outcomes, remaining nowadays the gold standard treatment of pulmonary regurgitation in rTOF patients. Nevertheless, transcatheter pulmonary valve implantation has emerged as a new, safe and efficient alternative to surgical valve replacement. In this review article, we try to evaluate and compare both techniques to find out which is the best therapeutic option in this patients.
Pulmonary Valve Insufficiency
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Patients with total repair of tetralogy of Fallot may have residual valvular dysfunction, the long-term effect of which is poorly defined. We prospectively studied 59 patients for 18 +/- 5 (mean +/- SD) years postoperatively by Doppler echocardiography and by 24-hour electrocardiographic monitoring. Right ventricular outflow gradients were estimated from the peak continuous-wave Doppler pulmonary artery velocity. The severity of valvular regurgitation was determined by mapping the proximal chamber by pulsed Doppler methods. Right ventricular diastolic cavity area was measured by planimetry of the apical image. The right ventricular outflow tract gradient had a mean value of 9.4 +/- 9.0 mm Hg (range, 0-58 mm Hg; median, 6.6 mm Hg). Pulmonary regurgitation was present in 78% of patients, with 59% of patients graded as mild and 19% as moderate. Tricuspid regurgitation was found in 65% of patients, with 56% of patients graded as mild, 7% as moderate, and 2% as severe. The severity of pulmonary regurgitation correlated with right ventricular cavity area (p less than 0.05). The severity of tricuspid regurgitation was not related to pulmonary stenosis or to the severity of pulmonary regurgitation. Aortic regurgitation is unusual (n = 11) and correlates with aortic root size. The frequency and type of ventricular arrhythmia were not related to the severity of pulmonary stenosis; however, ventricular bigeminy and couplets were related to the severity of pulmonary regurgitation (p less than 0.025). The majority of patients with total repair of tetralogy of Fallot have remarkably good long-term valvular function. For the minority with moderate or severe valvular dysfunction, pulmonary regurgitation is the best marker for ventricular arrhythmias.
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Pulmonary Valve Insufficiency
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Ventricular Function
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Almost 90% of children with congenital heart disease now reach adulthood due to the improved results of cardiac surgery and medical treatment. Among them, one of particular problems is pulmonary valve regurgitation after tetralogy of Fallot repair. About 20 years ago (1996), the mortality of tetralogy of Fallot has already been relatively good at about 5%, but now it is further reduced to about 2%. For this reason, it is conceivable that more and more adult patients with tetralogy of Fallot will increase in the future. Pulmonary valve regurgitation is often caused by the use of transannular patch repair. Surgical indications for pulmonary valve regurgitation include those with decreased exercise tolerance, right ventricular dysfunction, advanced right ventricular enlargement. We examined treatment strategies, valve selection and catheter valve implantation.
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Introduction: Transannular patch repair of tetralogy of Fallot (ToF) results in pulmonary insufficiency (PI) with dilation and distortion of the right ventricular outflow tract (RVOT) developing ov...
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Pulmonary Valve Insufficiency
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Pulmonary valve
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Abstract Background Right ventricular dysfunction in patients with tetralogy of Fallot and significant pulmonary regurgitation may lead to systolic dysfunction of the left ventricle due to altered ventricular interaction. We were interested in determining whether chronic pulmonary regurgitation affects the preload of the left ventricle. In addition, we wanted to study whether severe chronic pulmonary regurgitation would alter the preload of the left ventricle when compared with patients having preserved pulmonary valve annulus. Methods The study group comprised 38 patients with tetralogy of Fallot who underwent surgical repair between 1990 and 2003. Transannular patching was required in 21 patients to reconstruct the right ventricular outflow tract. Altogether, 48 age- and gender-matched healthy volunteers were recruited. Cardiac MRI was performed on all study patients to assess the atrial and ventricular volumes and function. Results Severe pulmonary regurgitation (>30 ml/m 2 ) was present in 13 patients, of whom 11 had a transannular patch, but only two had a preserved pulmonary valve annulus. The ventricular preload volumes from both atria were significantly reduced in patients with severe pulmonary regurgitation, and left ventricular stroke volumes (44.1±4.7 versus 58.9±10.7 ml/m 2 ; p<0.0001) were smaller compared with that in patients with pulmonary regurgitation <30 ml/m 2 or in controls. Conclusions In patients with tetralogy of Fallot, severe pulmonary regurgitation has a significant effect on volume flow through the left atrium. Reduction in left ventricular preload volume may be an additional factor contributing to left ventricular dysfunction.
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Pulmonary Valve Insufficiency
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