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The Mid-Term Results of Pulmonary Valve Replacement on the Right and Left Ventricular Functions in Adult Patients with Repair of Tetralogy of Fallot

Background : Pulmonary regurgitation (PR) after repair of tetralogy of Fallot (TOF) is a risk factor of right ventricular (RV) dysfunction and arrhythmia. The aim of this study was to evaluate the mid-term outcome of pulmonary valve replacement (PVR) using bioprosthetic valves in adult patients with PR after a TOF repair. Method : A total of 32 patients with repaired TOF, who underwent PVR in our hospital between April 2003 and March 2017, were retrospectively examined. The mean follow-up duration after the PVR was 5.4 ± 4.2 years. Deci-sion regarding the surgery was made on the basis of clinical symptoms, electrocardiography results, chest radiog-raphy, echocardiography findings, magnetic resonance imaging results, and cardiac catheter examination findings. Results : There was no perioperative mortality or the need for re-intervention after PVR. A patient underwent Bentall operation 3 years after PVR. RV end-diastolic volume index (RVEDVI) was significantly reduced (176.3 ± 57.2 mL/m 2 before to 108.1 ± 19.4 mL/m 2 after PVR, p ＜ 0.05). There was no diﬀerence in the RV ejection fraction (42.7 ％ ± 8.49 ％ before and 42.4 ％ ± 7.94 ％ after PVR, p ＞ 0.05). The left ventricular (LV) ejection fraction of RVEDVI group was ＜ 160 mL/m 2 , which showed an improvement; however, there was no significant statistical diﬀerence (55.3 ％ ± 8.03 ％ before and 58.5 ％ ± 4.95 ％ after PVR, p ＝ 0.12). It was significantly higher in postoperative left ventricular end-diastolic pressure (LVEDP) (15.2 ± 2.78 mmHg) of RVEDVI ≥ 160 mL/m 2 group than postoperative LVEDP (11.2 ± 2.81 mmHg) of RVEDVI ＜ 160 mL/m 2 group ( p ＜ 0.05). Conclusion : PVR after TOF repair in adult patients with PR is eﬀective and involves a low risk of mortality. It is suggested that 160 mL/m 2 of RVEDVI would be valid for determining whether surgery is indicated for the maintenance of RV and LV functions.