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Surgical and transcatheter pulmonary valve replacement in patients with repaired tetralogy of Fallot: cardiac magnetic resonance imaging characteristics and morphology of right ventricular outflow tract

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Abstract

Background

Pulmonary valve replacement is recommended in patients with repaired tetralogy of Fallot based on cardiac magnetic resonance imaging (MRI) criteria. This procedure is performed by surgical or transcatheter approaches.

Objective

We aimed to investigate the differences in preprocedural MRI characteristics (volume, function, strain) and morphology of the right ventricular outflow tract and branch pulmonary arteries in patients for whom surgical or transcatheter pulmonary valve replacement was planned.

Materials and methods

Cardiac MRI of 166 patients with tetralogy of Fallot were analyzed. Of these, 36 patients for whom pulmonary valve replacement was planned were included. Magnetic resonance imaging characteristics, right ventricular outflow tract morphology, branch pulmonary artery flow distribution and diameter were compared between surgical and transcatheter groups. Spearman correlation and Kruskal–Wallis tests were performed.

Results

Circumferential and radial MRI strain for the right ventricle were lower in the surgical group (P=0.045 and P=0.046, respectively). The diameter of the left pulmonary artery was significantly lower (P=0.021) and branch pulmonary artery flow and diameter ratio were higher (P=0.044 and P = 0.002, respectively) in the transcatheter group. There was a significant correlation between right ventricular outflow tract morphology and right ventricular end-diastolic volume index and global circumferential and radial MRI strain (P=0.046, P=0.046 and P= 0.049, respectively).

Conclusion

Preprocedural MRI strain, right-to-left pulmonary artery flow, diameter ratio and morphological features of the right ventricular outflow tract were significantly different between the two groups. A transcatheter approach may be recommended for patients with branch pulmonary artery stenosis, since both pulmonary valve replacement and branch pulmonary artery stenting can be performed in the same session.

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Data Availability

The data used to support the findings of this study are included in the article. The study cohort is available upon request for some participating centers but not all due to relevant data protection laws.

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Author information

Authors and Affiliations

  1. Department of Radiology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey

    Sercin Ozkok

  2. Department of Biomedical Engineering, Koç University, Rumelifeneri, Istanbul, Sarıyer, 34450, Turkey

    Sercin Ozkok

  3. Department of Radiology, Dr. Ilhan Varank Sancaktepe Training and Research Hospital, Istanbul, Turkey

    Hatice Ozge Ciftci

  4. Department of Biomedical Engineering, Istanbul Medipol University, Istanbul, Turkey

    Kevser Banu Kose

  5. Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey

    Ilker Kemal Yucel & Ahmet Celebi

  6. Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey

    Ahmet Sasmazel

  7. Department of Mechanical Engineering, Koç University, Istanbul, Turkey

    Kerem Pekkan

Authors
  1. Sercin Ozkok
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  2. Hatice Ozge Ciftci
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by S.O., B.K and O.K. The first draft of the manuscript was written by S.O.; all authors commented on the drafts of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sercin Ozkok.

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Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Istanbul Medeniyet University (Date, 25.12.2019 /No. 2019/052).

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Ozkok, S., Ciftci, H.O., Kose, K.B. et al. Surgical and transcatheter pulmonary valve replacement in patients with repaired tetralogy of Fallot: cardiac magnetic resonance imaging characteristics and morphology of right ventricular outflow tract. Pediatr Radiol 53, 1863–1873 (2023). https://doi.org/10.1007/s00247-023-05645-2

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  • DOI: https://doi.org/10.1007/s00247-023-05645-2

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