日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

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. Decision regarding the surgery was made on the basis of clinical symptoms, electrocardiography results, chest radiography, 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/m² before to 108.1±19.4 mL/m² 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/m², 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/m² group than postoperative LVEDP (11.2±2.81 mmHg) of RVEDVI ＜160 mL/m² 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/m² of RVEDVI would be valid for determining whether surgery is indicated for the maintenance of RV and LV functions.