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

Zdradzinski, Michael J

Qureshi, Athar M

Stewart, Robert

Pettersson, Gosta

Krasuski, Richard A

United States

2015-12-03T15:36:09Z

2014-07-15

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.

http://www.ncbi.nlm.nih.gov/pubmed/24878128

S0002-9149(14)01055-8

1879-1913

https://hdl.handle.net/10161/10988

eng

Elsevier BV

Am J Cardiol

10.1016/j.amjcard.2014.04.041

Adult

Cardiac Surgical Procedures

Echocardiography

Electrocardiography

Female

Follow-Up Studies

Humans

Male

Middle Aged

Postoperative Period

Pulmonary Valve Stenosis

Retrospective Studies

Stroke Volume

Tetralogy of Fallot

Time Factors

Treatment Outcome

Ventricular Function, Left

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

Journal article

Krasuski, Richard A|0000-0003-3150-5215

http://www.ncbi.nlm.nih.gov/pubmed/24878128

300

304

2

Clinical Science Departments

Duke

Medicine

Medicine, Cardiology

School of Medicine

Published

114