Long-Term Effects of Pulmonary Valve Implantation and Prosthesis Evolution in Patients with Repaired Tetralogy of Fallot. / Efeitos de Longo Prazo do Implante Valvar Pulmonar e Evolução da Prótese em Pacientes com Tetralogia de Fallot Corrigida.
Arq Bras Cardiol
; 121(7): e20230585, 2024 Jun.
Article
en Pt, En
| MEDLINE
| ID: mdl-39082573
ABSTRACT
BACKGROUND:
Pulmonary valve regurgitation is a significant long-term complication in patients with tetralogy of Fallot (TOF).OBJECTIVE:
This study aims to investigate the effects of pulmonary valve implantation (PVI) on the anatomy and function of the right ventricle (RV) and the long-term evolution of the implanted prosthesis in the pulmonary position.METHODS:
A single-center retrospective cohort analysis was performed in 56 consecutive patients with TOF who underwent PVI. The study included patients of both sexes, aged ≥ 12 years, and involved assessing clinical and surgical data, pre- and post-operative cardiovascular magnetic resonance imaging, and echocardiogram data more than 1 year after PVI.RESULTS:
After PVI, there was a significant decrease in RV end-systolic volume indexed by body surface area (BSA), from 89 mL/BSA to 69 mL/BSA (p < 0.001) and indexed RV end-diastolic volume, from 157 mL/BSA to 116 mL/BSA (p < 0.001). Moreover, there was an increase in corrected RV ejection fraction [ RVEFC = net pulmonary flow (pulmonary forward flow - regurgitant flow) / R V end-diastolic volume ] from 23% to 35% (p < 0.001) and left ventricular ejection fraction from 58% to 60% (p = 0.008). However, a progressive increase in the peak pulmonary valve gradient was observed over time, with 25% of patients experiencing a gradient exceeding 60 mmHg. Smaller prostheses (sizes 19 to 23) were associated with a 4.3-fold higher risk of a gradient > 60 mmHg compared to larger prostheses (sizes 25 to 27; p = 0.029; confidence interval 1.18 to 17.8).CONCLUSION:
As expected, PVI demonstrated improvements in RV volumes and function. Long-term follow-up and surveillance are crucial for assessing the durability of the prosthesis and detecting potential complications. Proper sizing of prostheses is essential for improved prosthesis longevity.
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Válvula Pulmonar
/
Insuficiencia de la Válvula Pulmonar
/
Tetralogía de Fallot
/
Prótesis Valvulares Cardíacas
/
Implantación de Prótesis de Válvulas Cardíacas
Idioma:
En
/
Pt
Revista:
Arq Bras Cardiol
Año:
2024
Tipo del documento:
Article