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The left heart after pulmonary valve replacement in adults late after tetralogy of Fallot repair
- Source :
- International journal of cardiology. 160(3)
- Publication Year :
- 2010
-
Abstract
- Adverse ventricular-ventricular interactions have been recognized in those with repaired tetralogy of Fallot (TOF) and severe pulmonary regurgitation.We aimed to examine the impact of pulmonary valve replacement (PVR) on the left heart late after TOF repair.Left ventricular (LV) volumes and ejection fractions (EF) were analyzed in adults with severe pulmonary regurgitation after TOF repair with cardiac magnetic resonance imaging (CMR) before and after PVR. Thirty-nine patients (median age 33[20-65] years) were reviewed. Post-PVR, LVEF improved significantly in the entire cohort (50 ± 9%→54 ± 7%, p0.001) and in those with moderately impaired (defined as LVEF ≤ 45%) preoperative LVEF (38 ± 5%→47 ± 6%, p0.0001), but was not statistically different in those with relatively preserved (defined as LVEF45%) preoperative LVEF. By multivariate linear regression analysis to evaluate independent CMR predictors of improved LVEF post-PVR for the entire cohort, the only CMR variable to emerge was preoperative LVEF (p=0.012, regression coefficient -0.54, SE 0.13). Whereas PVR resulted in increased LV filling in patients with relatively preserved preoperative LVEF reflected by an increase in LV end-diastolic volumes (77 ± 10→82 ± 16 mL/m(2), p=0.05), LV end-systolic volumes decreased after PVR in patients with impaired preoperative LVEF (65 ± 12→54 ± 10 mL/m(2), p=0.001) but LV end-diastolic volumes were not significantly changed.When LVEF is decreased after TOF repair, PVR appears to have a salutary effect on postoperative LVEF, thereby supporting the concept of recovery of adverse right-left heart interactions. Mechanisms of left heart improvement post-PVR differ depending on degree of preoperative LV systolic dysfunction.
- Subjects :
- Adult
Male
medicine.medical_specialty
Ventricular Function, Left
Young Adult
Cardiac magnetic resonance imaging
Internal medicine
Pulmonary Valve Replacement
Pulmonary regurgitation
medicine
Humans
In patient
cardiovascular diseases
Postoperative Period
Tetralogy of Fallot
Aged
Retrospective Studies
Heart Valve Prosthesis Implantation
Ejection fraction
medicine.diagnostic_test
business.industry
Magnetic resonance imaging
Stroke Volume
Middle Aged
medicine.disease
eye diseases
Pulmonary Valve Insufficiency
Cross-Sectional Studies
Treatment Outcome
Cohort
cardiovascular system
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
circulatory and respiratory physiology
Subjects
Details
- ISSN :
- 18741754
- Volume :
- 160
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- International journal of cardiology
- Accession number :
- edsair.doi.dedup.....c00a03220244eea3e0b082bf5b4b559d