- 期刊
- OpenAccess
Right Ventricular Volume Reduction after Different Types of Pulmonary Valve Replacement in Repaired Tetralogy of Fallot
摘要
PURPOSE. Right ventricular (RV) dilatation due to pulmonary regurgitation (PR) is common in repaired tetralogy of Fallot (rTOF). Pulmonary valve replacement (PVR) surgery eliminates PR and can reverse RV dilatation. This study analyzed the types of PVR and other factors related to RV reduction. MATERIALS AND METHODS. We retrospectively reviewed data on patients with rTOF who underwent PVR between 2009 and 2019 and received magnetic resonance imaging (MRI) before and after the operation. Three types of valves were employed for PVR, namely bioprosthetic, polytetrafluoroethylene tricuspid, and polytetrafluoroethylene monocuspid valves. The type of PVR, duration after PVR, and indices of the right ventricle measured through MRI before and after the operation were analyzed. RESULTS. We analyzed 36 patients and 72 examinations. PVR with a bioprosthetic valve significantly reduced the RV end-diastolic volume index, RV end-systolic volume index, and PR after the operation. However, this improvement was not observed in patients in the polytetrafluoroethylene monocuspid group, who exhibited a smaller reduction in the postoperative RV end-diastolic volume index (median 158.5 mL/m^2, range 139.3-200.3 mL/m^2) than did those in the bioprosthetic group (median 121.1 mL/m^2, range 82.2-177.4 mL/m^2, p = 0.006) and the polytetrafluoroethylene tricuspid group (median 123.6 mL/ m^2, range 105.7-182.9 mL/m^2, p = 0.109). The polytetrafluoroethylene monocuspid group exhibited the smallest improvement in postoperative PR of all the groups (median 38.9%, range 20.6%-67.7%). CONCLUSION. A handmade polytetrafluoroethylene monocuspid valve is less effective for surgical PVR than polytetrafluoroethylene tricuspid and bioprosthetic valves in reducing both RV dilatation and PR in rTOF. Hence, bioprosthetic valves rather than polytetrafluoroethylene valves are the optimal choice for PVR in patients with rTOF.