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Timing of Pulmonary Valve Replacement: How Much Can the Right Ventricle Dilate Before it Looses Its Remodeling Potential?

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Abstract

Congenital heart disease patients that develop secondary pulmonary regurgitation require a pulmonary valve replacement (PVR) in their follow-up. The indications for PVR in asymptomatic patients are debated. Most guidelines consider a RV end-diastolic volume (RVEDV) over 150 ml/m2 as an indication for PVR. We analyzed clinical, echocardiographic and MRI variables of patients that underwent a surgical PVR between September 2006 and February 2013. The included patients were asymptomatic, without pulmonary stenosis and with both pre- and post-surgery MRI. Thirty-five patients (74.3 % males) were included. Mean age at PVR was 25.8 years (SD = 7.18), and weight was 64.5 Kg (SD = 12.03). The main diagnosis was tetralogy of Fallot (n = 28), pulmonary atresia (n = 2), primary pulmonary regurgitation (n = 2) and pulmonary regurgitation after percutaneous treatment (n = 2). The maximal RVEDV pre-PVR was 267 ml/m2, and right ventricular end-systolic volume (RVESV) was 183 ml/m2. RV size and function were established by MRI:

 

Pre-PVR

Post-PVR

p

RVEDV (ml/m2)

162 (SD = 39.1)

94 (SD = 23.6)

<0.001

RVESV (ml/m2)

87 (SD = 28.9)

44 (SD = 15.7)

<0.001

RVEF

44.8 % (SD = 8.17)

52 % (SD = 9.9)

<0.001

Patients with a RVEDV under 170 ml/m2 combined with a RVESV under 90 ml/m2 had a favorable RV remodeling, defined as RVEDV under 110 ml/m2 (sensitivity 87.5 %), RVESV under 55 ml/m2 (sensitivity 100 %) and RVEF over 50 % (sensitivity 100 %). When deciding the optimal PVR timing in asymptomatic patients, both RVEDV and RVESV should be considered. Our results suggest that higher volumes than used in the clinical practice can achieve a good remodeling. Therefore, PVR could be performed later in the follow-up reducing the number of cardiac interventions.

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Authors and Affiliations

  1. Pediatric Cardiology Department, Hospital Ramón y Cajal, Carretera de Colmenar Viejo Km 9,100, 28034, Madrid, Spain

    M. Alvarez-Fuente, E. Garrido-Lestache, L. Fernandez-Pineda, I. Sánchez, C. Abelleira, S. Villagrá, R. Tamariz, E. Barrios, M. J. Lamas & M. J. Del Cerro

  2. Radiology Department, Hospital Ramón y Cajal, Madrid, Spain

    B. Romera

  3. Pediatric Cardiac Surgery Department, Hospital Ramón y Cajal, Madrid, Spain

    T. Centella & R. Gomez

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  1. M. Alvarez-Fuente
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  2. E. Garrido-Lestache
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Correspondence to M. Alvarez-Fuente.

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Alvarez-Fuente, M., Garrido-Lestache, E., Fernandez-Pineda, L. et al. Timing of Pulmonary Valve Replacement: How Much Can the Right Ventricle Dilate Before it Looses Its Remodeling Potential?. Pediatr Cardiol 37, 601–605 (2016). https://doi.org/10.1007/s00246-015-1320-4

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  • DOI: https://doi.org/10.1007/s00246-015-1320-4

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