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Slouha E, Trygg G, Tariq AH, La A, Shay A, Gorantla VR. Pulmonary Valve Replacement Timing Following Initial Tetralogy of Fallot Repair: A Systematic Review. Cureus 2023; 15:e49577. [PMID: 38156158 PMCID: PMC10754298 DOI: 10.7759/cureus.49577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
Pulmonary valve replacement (PVR) is a critical aspect of surgical management for patients with tetralogy of Fallot (ToF). Determining an optimal timeframe for intervention is imperative, as it directly impacts long-term outcomes and the risk of complications in ToF patients. Ventriculotomy with the transannular patch is currently indicated for right ventricular outflow tract obstruction, but the patch itself can lead to pulmonary regurgitation (PR), dyspnea, and cyanosis, among other complications. This investigation seeks to establish an evidence-based timeline to enhance the overall quality of care for individuals with this congenital heart condition. From 2002 to 2022, 21,935 articles regarding the PVR timing for ToF were examined and filtered. The publications were screened using PRISMA guidelines, and 32 studies were included for analysis and review. Among the studies, PVR was strongly indicated for patients who had developed severe PR, especially in asymptomatic patients and those experiencing fatigue and exercise intolerance. Severe PR was associated with arrhythmias such as right bundle branch block, atrioventricular block, and prolonged QRS intervals, in which male sex and high right ventricular end-diastolic volume (RVEDV) were significant predictors of long preoperative QRS duration. Most physicians found RVEDV necessary for making surgical referrals despite a lack of correlation between PR severity and RVEDV or indexed right ventricular end-systolic volume (RVESVi). However, asymptomatic ToF patients with preoperative RVESVi benefited from PVR. Except for some variations in QRS intervals among studies, arrhythmias tended to persist post-op, yet NYHA functional class and RV size improved significantly following PVR. Older age at PVR was found to be associated with adverse cardiac events, whereas early PVR presented with appropriately short QRS intervals. Cardiac function tended to be significantly worse in patients undergoing late PVR versus early PVR, with timelines ranging from one to three decades following initial ToF repair. Choosing the best timeline for PVR largely depends on the patient's baseline cardiopulmonary presentation, and additional quantitative deformation analysis can help predict an appropriate timeline for ToF patients.
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Affiliation(s)
- Ethan Slouha
- Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Genevieve Trygg
- Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Abdul Hadi Tariq
- Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Anthony La
- Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Allison Shay
- Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Vasavi R Gorantla
- Biomedical Sciences, West Virginia School of Osteopathic Medicine, Lewisburg, USA
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Is the QRS duration useful for determining the optimal timing of pulmonary valve replacement after tetralogy of Fallot repair? Gen Thorac Cardiovasc Surg 2022:10.1007/s11748-022-01898-0. [DOI: 10.1007/s11748-022-01898-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
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Ohuchi H, Kawata M, Uemura H, Akagi T, Yao A, Senzaki H, Kasahara S, Ichikawa H, Motoki H, Syoda M, Sugiyama H, Tsutsui H, Inai K, Suzuki T, Sakamoto K, Tatebe S, Ishizu T, Shiina Y, Tateno S, Miyazaki A, Toh N, Sakamoto I, Izumi C, Mizuno Y, Kato A, Sagawa K, Ochiai R, Ichida F, Kimura T, Matsuda H, Niwa K. JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair. Circ J 2022; 86:1591-1690. [DOI: 10.1253/circj.cj-22-0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideo Ohuchi
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, National Cerebral and Cardiovascular Center
| | - Masaaki Kawata
- Division of Pediatric and Congenital Cardiovascular Surgery, Jichi Children’s Medical Center Tochigi
| | - Hideki Uemura
- Congenital Heart Disease Center, Nara Medical University
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Atsushi Yao
- Division for Health Service Promotion, University of Tokyo
| | - Hideaki Senzaki
- Department of Pediatrics, International University of Health and Welfare
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Morio Syoda
- Department of Cardiology, Tokyo Women’s Medical University
| | - Hisashi Sugiyama
- Department of Pediatric Cardiology, Seirei Hamamatsu General Hospital
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Kei Inai
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women’s Medical University
| | - Takaaki Suzuki
- Department of Pediatric Cardiac Surgery, Saitama Medical University
| | | | - Syunsuke Tatebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Tomoko Ishizu
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Yumi Shiina
- Cardiovascular Center, St. Luke’s International Hospital
| | - Shigeru Tateno
- Department of Pediatrics, Chiba Kaihin Municipal Hospital
| | - Aya Miyazaki
- Division of Congenital Heart Disease, Department of Transition Medicine, Shizuoka General Hospital
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Ichiro Sakamoto
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiko Mizuno
- Faculty of Nursing, Tokyo University of Information Sciences
| | - Atsuko Kato
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Koichi Sagawa
- Department of Pediatric Cardiology, Fukuoka Children’s Hospital
| | - Ryota Ochiai
- Department of Adult Nursing, Yokohama City University
| | - Fukiko Ichida
- Department of Pediatrics, International University of Health and Welfare
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Koichiro Niwa
- Department of Cardiology, St. Luke’s International Hospital
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Yacoub MH, Hosny H, Afifi A, Nagy M, Mahgoub A, Simry W, AbouZeina MG, Doss R, El Sawy A, Shehata N, Elafifi A, Abdullah H, Romeih S. Novel concepts and early results of repairing common arterial trunk. Eur J Cardiothorac Surg 2021; 61:562-571. [PMID: 34347066 PMCID: PMC8922708 DOI: 10.1093/ejcts/ezab336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/14/2021] [Accepted: 06/21/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Common Arterial Trunk (CAT) continues to have a very poor prognosis globally. To address that, we have developed a novel technique targeting key concepts for the correction of all components of the anomaly, using autologous arterial tissue. This aims to enhance results, availability worldwide, and importantly to avoid the need for repeated reoperations. METHODS From January 2019 to 4 January 2021, all patients with isolated CAT had repair of the defect using autologous arterial trunk tissue with direct right ventricle (RV) to pulmonary artery (PA) connection. Clinical outcomes, follow-up which included multi-slice computed tomography 3D segmentation and 4D cardiovascular magnetic resonance flow, are presented. RESULTS Twenty patients were included in the study (median age 4.5 months). There were 2 hospital deaths due to systemic infection and pulmonary hypertensive crisis, respectively. Following discharge all patients remained asymptomatic with no signs of heart failure and improved pattern of growth (median follow-up: 8 months). Early postoperative 3D segmentation showed a conical shaped neo-right ventricular outflow chamber connecting the body of the RV to the main PA through a valveless ostium, and normal crossing of PA and neo-aorta. 4D cardiovascular magnetic resonance pattern of flow showed normal rapid laminar flow through the atrioventricular valves followed by a vortex towards the outflow tracts. There was laminar flow through the neo-aorta and neo-PA with velocity not exceeding 2.5 m/s. The PA regurgitant fraction was 25 ± 5% and was limited to early diastole. CONCLUSIONS The initial results of utilizing the key concepts, using autologous arterial tissue for the repair of CAT, are encouraging, both clinically and by multimodality imaging.
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Affiliation(s)
- Magdi H Yacoub
- Cardiac Surgery Department, Aswan Heart Centre, Aswan, Egypt.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Hatem Hosny
- Cardiac Surgery Department, Aswan Heart Centre, Aswan, Egypt
| | - Ahmed Afifi
- Cardiac Surgery Department, Aswan Heart Centre, Aswan, Egypt.,Cardiac Surgery Department, National Heart Institute, Giza, Egypt
| | - Mohamed Nagy
- Biomedical Engineering and Innovation Laboratory, Aswan Heart Centre, Aswan, Egypt
| | - Ahmed Mahgoub
- Cardiac Surgery Department, Aswan Heart Centre, Aswan, Egypt
| | - Walid Simry
- Cardiac Surgery Department, Aswan Heart Centre, Aswan, Egypt.,Cardiac Surgery Department, National Heart Institute, Giza, Egypt
| | | | - Ramy Doss
- Internal Medicine Department, Baylor University Medical Center, Dallas, TX, USA
| | - Amr El Sawy
- Biomedical Engineering and Innovation Laboratory, Aswan Heart Centre, Aswan, Egypt
| | - Nairouz Shehata
- Biomedical Engineering and Innovation Laboratory, Aswan Heart Centre, Aswan, Egypt
| | | | - Hedaia Abdullah
- Pediatric Intensive Care unit, Aswan Heart Centre, Aswan, Egypt
| | - Soha Romeih
- Radiology Department, Aswan Heart Centre, Aswan, Egypt.,Cardiology Department, Tanta University, Tanta, Egypt
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Rozzi G, Lo Muzio FP, Fassina L, Rossi S, Statello R, Sandrini C, Laricchiuta M, Faggian G, Miragoli M, Luciani GB. Right ventricular functional recovery depends on timing of pulmonary valve replacement in tetralogy of Fallot: a video kinematic study. Eur J Cardiothorac Surg 2021; 59:1329-1336. [PMID: 33547473 DOI: 10.1093/ejcts/ezab026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/19/2020] [Accepted: 12/07/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Indications for and timing of pulmonary valve replacement (PVR) after tetralogy of Fallot repair are controversial. Among magnetic resonance imaging indices proposed to time valve replacement, a right ventricular (RV) end-diastolic volume index greater than 160 ml/m2 is often used. Recent evidence suggests that this value may still identify patients with irreversible RV dysfunction, thus hindering recovery. Our goal was to define, using intraoperative video kinematic evaluation, whether a relationship exists between timing of PVR and early functional recovery after surgery. METHODS Between November 2016 and November 2018, a total of 12 consecutive patients aged 27.1 ± 19.1 years underwent PVR on average 22.2 ± 13.3 years after tetralogy of Fallot repair. Mean RV end-diastolic volume evident on the magnetic resonance images was 136.9 ± 35.7 ml/m2. Intraoperative cardiac kinematics were assessed by video kinematic evaluation via a high-speed camera acquiring videos at 200 fps before and after valve replacement. RESULTS Patients presenting with RV end-diastolic volume <147 ml/m2 were significantly younger (11.2 ± 5.0 vs 38.4 ± 17.0; P = 0.005) and had a shorter time interval to valve replacement (11.0 ± 5.2 vs 30.1 ± 11.3; P = 0.03). The entire population showed a moderate correlation among energy expenditure, cardiac fatigue, perimeter of contraction and preoperative RV end-diastolic volume index. Both groups showed a reduction in all kinematic parameters after PVR, but those with end-diastolic volume >147 ml/m2 showed an unpredictable outcome. CONCLUSIONS Video kinematic evaluation provides insight into intraoperative RV recovery in patients with tetralogy of Fallot undergoing PVR. Accordingly, functional recovery can be expected in patients with preoperative end-diastolic volume <147 ml/m2.
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Affiliation(s)
- Giacomo Rozzi
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy.,Departement of Molecular Cardiology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Francesco Paolo Lo Muzio
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Lorenzo Fassina
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Stefano Rossi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Rosario Statello
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Maira Laricchiuta
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - Giuseppe Faggian
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - Michele Miragoli
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Departement of Molecular Cardiology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
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Cocomello L, Sinha S, Gonzalez Corcia MC, Baquedano M, Benedetto U, Caputo M. Determinants of QRS duration in patients with tetralogy of Fallot after pulmonary valve replacement. J Card Surg 2021; 36:1958-1968. [PMID: 33651426 DOI: 10.1111/jocs.15469] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/03/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Following the repair of TOF patients may be left with pulmonary regurgitation and a dilated right ventricle (RV), which in turn can lead to ventricular arrhythmias and sudden death. A prolonged QRS is a predictor of ventricular arrhythmias. However, whether subsequent pulmonary valve replacement (PVR) can reverse QRS-prolongation is controversial. We hypothesized that changes in QRS duration following PVR are determined by preoperative QRS-duration and RV volumes METHODS: A retrospective single-center cohort study was conducted on 142 post-TOF repair patients (mean age 25 ± 13 years) who underwent PVR between 1995 and 2019. Information on QRS duration and RV volumes measured by cardiac MRI (available in 83 patients) were collected. A linear mixed model was used to investigate the association between the preoperative QRS duration and RV volumes and the postoperative QRS duration. RESULTS The QRS-duration following PVR continued to increase in all subjects with a prolonged preoperative QRS-duration(>160 ms, rate of increase of 0.87 msec ± 0.33 per year; p = .01), markedly raised RV end-diastolic volume (RVEDV; ≥166 ml/m2, rate of increase of 2.0 msec ± 0.37 per year; p < .01) or RV end-systolic volume (RVESV; ≥89 ml/m2 , rate of increase of 1.25 msec ± 0.43 per year; p = .01). In contrast, in patients with preoperative QRS-duration <160 msec (p = .16), RVEDV <166 ml/m2 (p = .14), or RVESV < 89 ml/m2 (p = .37), the QRS-duration did not change significantly when compared to preoperative values. CONCLUSIONS In subjects with shorter QRS and smaller RV volumes, QRS duration did not show further prolongation following PVR. While markedly prolonged QRS and increased RV volumes were associated with a small but constant increase in QRS duration despite PVR.
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Affiliation(s)
- Lucia Cocomello
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Shubhra Sinha
- Department of Translational Health Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
| | | | - Mai Baquedano
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | | | - Massimo Caputo
- Bristol Heart Institute, University of Bristol, Bristol, UK
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