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European Heart Journal Advance Access published online on October 7, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi581
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received January 17, 2005
Revised August 29, 2005
Accepted September 15, 2005

Clinical research

Remodelling of the right ventricle after early pulmonary valve replacement in children with repaired tetralogy of Fallot: assessment by cardiovascular magnetic resonance

Emanuela R. Valsangiacomo Buechel 1*, Hitendu H. Dave 2, Christian J. Kellenberger 3, Ali Dodge-Khatami 2, Rene Pretre 2, Felix Berger 1, and Urs Bauersfeld 1

1 Division of Pediatric Cardiology, University Children's Hospital, Steinwiesstr. 75, CH-8032 Zurich, Switzerland
2 Division of Congenital Cardiovascular Surgery, University Children's Hospital, Zurich, Switzerland
3 Division of Diagnostic Imaging, University Children's Hospital, Zurich, Switzerland

* To whom correspondence should be addressed.
Emanuela R. Valsangiacomo Buechel, E-mail: emanuela.valsangiacomo{at}kispi.unizh.ch


  Abstract

Aims Correct timing of pulmonary valve replacement (PVR) is crucial for preventing complications of pulmonary regurgitation and right ventricular (RV) dilatation after repair of tetralogy of Fallot. We sought to assess the remodelling of the RV after early PVR in children, using cardiovascular magnetic resonance (CMR).

Methods and results Twenty children with severe pulmonary regurgitation and RV dilatation and mean age 13.9 ± 3 years underwent CMR evaluation 5.6 ± 1.8 months before and 5.9 ± 0.6 months after PVR. PVR was performed when the RV end-diastolic volume exceeded 150 mL/m2, as measured by CMR. The time interval between primary repair and PVR was 12 ± 3 years. Post-operative CMR demonstrated a significant reduction of the RV end-diastolic volume from 189.8 ± 33.4 to 108.7 ± 25.8 mL/m2 (P < 0.0001), of the RV end-systolic volume from 102.4 ± 27.3 to 58.2 ± 16.3 mL/m2 (P < 0.0001), and of the RV mass from 48.7 ± 12.3 to 35.8 ± 7.7 g/m2 (P < 0.0001). The RV ejection fraction did not change significantly.

Conclusion Prompt RV remodelling, with reduction of RV volume and mass, is observed after performing PVR if the RV end-diastolic volume exceeds 150 mL/m2. Early PVR may prevent the detrimental complications of severe pulmonary regurgitation.

Keywords: Tetralogy of Fallot; Right ventricle; Remodelling; Magnetic resonance imaging.
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