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Comparison of long-term postoperative sequelae in patients with tetralogy of Fallot versus isolated pulmonic stenosis.

dc.contributor.author Krasuski, Richard Andrew
dc.contributor.author Pettersson, Gosta B
dc.contributor.author Qureshi, AM
dc.contributor.author Stewart, R
dc.contributor.author Zdradzinski, MJ
dc.coverage.spatial United States
dc.date.accessioned 2015-12-03T15:36:09Z
dc.date.issued 2014-07-15
dc.identifier http://www.ncbi.nlm.nih.gov/pubmed/24878128
dc.identifier S0002-9149(14)01055-8
dc.identifier.uri http://hdl.handle.net/10161/10988
dc.description.abstract Patients with tetralogy of Fallot (TOF) after complete repair and pulmonic stenosis (PS) after surgical valvotomy often develop significant pulmonic regurgitation (PR) that eventually requires valve replacement. Although criteria exist for the timing of pulmonary valve replacement in TOF, it remains less clear when to intervene in valvotomy patients and whether TOF recommendations can be applied. Our aim was to compare the structural and functional sequelae of valvotomy for PS with complete repair for TOF. We compared the clinical characteristics, electrocardiograms, echocardiograms, cardiac magnetic resonance imaging (MRI), and invasive hemodynamics of 109 adults (34 PS and 75 TOF) newly referred to a congenital heart disease center for evaluation of PR between 2005 and 2012. Both cohorts were similar in terms of baseline demographics and presenting New York Heart Association function class. Valvotomy patients had a slightly greater degree of PR by echocardiogram, although it was similar by cardiac MRI. Electrocardiography QRS width was greater in patients with TOF (114±27 vs 150±28 ms, p<0.001). MRI right ventricular ejection fraction (49±8 vs 41±11%, p=0.001) and left ventricular ejection fraction (59±7 vs 52±10%, p=0.002) were lower in patients with TOF. Pacemaker or defibrillator implantation was significantly greater in patients with TOF (3% vs 23%, p=0.011). In conclusion, patients postvalvotomy and complete repair present with similar degrees of PR and severity of symptoms. Biventricular systolic function and electrocardiography QRS width appear less affected, suggesting morphologic changes in TOF and its repair that extend beyond the effects of PR. These findings suggest the need for developing disease-specific guidelines for patients with PR postvalvotomy.
dc.language eng
dc.relation.ispartof Am J Cardiol
dc.relation.isversionof 10.1016/j.amjcard.2014.04.041
dc.subject Adult
dc.subject Cardiac Surgical Procedures
dc.subject Echocardiography
dc.subject Electrocardiography
dc.subject Female
dc.subject Follow-Up Studies
dc.subject Humans
dc.subject Male
dc.subject Middle Aged
dc.subject Postoperative Period
dc.subject Pulmonary Valve Stenosis
dc.subject Retrospective Studies
dc.subject Stroke Volume
dc.subject Tetralogy of Fallot
dc.subject Time Factors
dc.subject Treatment Outcome
dc.subject Ventricular Function, Left
dc.title Comparison of long-term postoperative sequelae in patients with tetralogy of Fallot versus isolated pulmonic stenosis.
dc.type Journal article
pubs.author-url http://www.ncbi.nlm.nih.gov/pubmed/24878128
pubs.begin-page 300
pubs.end-page 304
pubs.issue 2
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group Medicine
pubs.organisational-group Medicine, Cardiology
pubs.organisational-group School of Medicine
pubs.publication-status Published
pubs.volume 114
dc.identifier.eissn 1879-1913


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