Long-Term Effects of Pulmonary Valve Implantation and Prosthesis Evolution in Patients with Repaired Tetralogy of Fallot

• Published in: Arquivos brasileiros de cardiologia 2024-06, Vol.121 (7), p.e20230585
• Main Authors: Caneo, Luiz Fernando, Turquetto, Aida Luiza Ribeiro, Boschiero, Matheus Negri, Amato, Luciana Patrick, Ishikawa, Walther Yoshiharu, Hodas, Fabiana Padilha, Ligeiro, Melissa Ganeko, Agostinho, Daniela Regina, Miana, Leonardo Augusto, Tanamati, Carla, Gonçalves, Rilvani Cavalcante, Penha, Juliano Gomes, Massoti, Maria Raquel Brigoni, Jatene, Marcelo Biscegli, Jatene, Fabio Biscegli
• Format: Article
• Language: eng ; por
• Subjects: Adolescent; Adult; Child; Echocardiography; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Magnetic Resonance Imaging; Male; Postoperative Period; Pulmonary Valve - diagnostic imaging; Pulmonary Valve - physiopathology; Pulmonary Valve - surgery; Pulmonary Valve Insufficiency - diagnostic imaging; Pulmonary Valve Insufficiency - etiology; Pulmonary Valve Insufficiency - physiopathology; Pulmonary Valve Insufficiency - surgery; Retrospective Studies; Stroke Volume - physiology; Tetralogy of Fallot - diagnostic imaging; Tetralogy of Fallot - physiopathology; Tetralogy of Fallot - surgery; Time Factors; Treatment Outcome; Ventricular Function, Right - physiology; Young Adult
• ISSN: 1678-4170; 1678-4170
• DOI: 10.36660/abc.20230585

Pulmonary valve regurgitation is a significant long-term complication in patients with tetralogy of Fallot (TOF). This study aims to investigate the effects of pulmonary valve implantation (PVI) on the anatomy and function of the right ventricle (RV) and the long-term evolution of the implanted prosthesis in the pulmonary position. A single-center retrospective cohort analysis was performed in 56 consecutive patients with TOF who underwent PVI. The study included patients of both sexes, aged ≥ 12 years, and involved assessing clinical and surgical data, pre- and post-operative cardiovascular magnetic resonance imaging, and echocardiogram data more than 1 year after PVI. After PVI, there was a significant decrease in RV end-systolic volume indexed by body surface area (BSA), from 89 mL/BSA to 69 mL/BSA (p < 0.001) and indexed RV end-diastolic volume, from 157 mL/BSA to 116 mL/BSA (p < 0.001). Moreover, there was an increase in corrected RV ejection fraction [ RVEFC = net pulmonary flow (pulmonary forward flow - regurgitant flow) / R V end-diastolic volume ] from 23% to 35% (p < 0.001) and left ventricular ejection fraction from 58% to 60% (p = 0.008). However, a progressive increase in the peak pulmonary valve gradient was observed over time, with 25% of patients experiencing a gradient exceeding 60 mmHg. Smaller prostheses (sizes 19 to 23) were associated with a 4.3-fold higher risk of a gradient > 60 mmHg compared to larger prostheses (sizes 25 to 27; p = 0.029; confidence interval: 1.18 to 17.8). As expected, PVI demonstrated improvements in RV volumes and function. Long-term follow-up and surveillance are crucial for assessing the durability of the prosthesis and detecting potential complications. Proper sizing of prostheses is essential for improved prosthesis longevity.