Timing for RVOT Management

  • Harald Kaemmerer
  • Andreas Eicken
  • John Hess


The long-term survival and the overall outcome for patients after surgical repair of ToF are favorable [1, 2]. Nevertheless in many cases significant residues and sequelae persist or develop.


Right Ventricular Cardiac Magnetic Resonance Tricuspid Regurgitation Pulmonary Regurgitation Pulmonary Valve Replacement 
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  1. 1.
    Nollert G, Fischlein T, Bouterwek S et al (1997) Long-term survival in patients with repair of tetralogy of Fallot: 36-year follow-up of 490 survivors of the first year after surgical repair. J Am Coll Cardiol 30:1374–1383PubMedCrossRefGoogle Scholar
  2. 2.
    Hickey EJ, Veldtman G, Bradley TJ et al (2009) Late risk of outcomes for adults with repaired tetralogy of Fallot from an inception cohort spanning four decades. Eur J Cardiothorac Surg 35:156–164PubMedCrossRefGoogle Scholar
  3. 3.
    Graham TP Jr (2002) Management of pulmonary regurgitation after tetralogy of fallot repair. Curr Cardiol Rep 4:63–67PubMedCrossRefGoogle Scholar
  4. 4.
    Redington AN (2006) Determinants and assessment of pulmonary regurgitation in tetralogy of Fallot: practice and pitfalls. Cardiol Clin 24:631–9, viiPubMedCrossRefGoogle Scholar
  5. 5.
    Bouzas B, Kilner PJ, Gatzoulis MA (2005) Pulmonary regurgitation: not a benign lesion. Eur Heart J 26:433–439PubMedCrossRefGoogle Scholar
  6. 6.
    van Straten A, Vliegen HW, Hazekamp MG et al (2004) Right ventricular function after pulmonary valve replacement in patients with tetralogy of Fallot. Radiology 233:824–829PubMedCrossRefGoogle Scholar
  7. 7.
    Babu-Narayan SV, Kilner PJ, Li W et al (2006) Ventricular fibrosis suggested by cardiovascular magnetic resonance in adults with repaired tetralogy of fallot and its relationship to adverse markers of clinical outcome. Circulation 113:405–413PubMedCrossRefGoogle Scholar
  8. 8.
    Silka MJ, Hardy BG, Menashe VD, Morris CD (1998) A population-based prospective evaluation of risk of sudden cardiac death after operation for common congenital heart defects. J Am Coll Cardiol 32:245–251PubMedCrossRefGoogle Scholar
  9. 9.
    Shimazaki Y, Blackstone EH, Kirklin JW (1984) The natural history of isolated congenital pulmonary valve incompetence: surgical implications. Thorac Cardiovasc Surg 32:257–259PubMedCrossRefGoogle Scholar
  10. 10.
    Geva T (2006) Indications and timing of pulmonary valve replacement after tetralogy of Fallot repair. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 11–22Google Scholar
  11. 11.
    Tobler D, Crean AM, Redington AN et al (2011) The left heart after pulmonary valve replacement in adults late after tetralogy of Fallot repair. Int J Cardiol [Epub ahead of print]Google Scholar
  12. 12.
    Geva T, Sandweiss BM, Gauvreau K et al (2004) Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging. J Am Coll Cardiol 43:1068–1074PubMedCrossRefGoogle Scholar
  13. 13.
    Davlouros PA, Kilner PJ, Hornung TS et al (2002) Right ventricular function in adults with repaired tetralogy of Fallot assessed with cardiovascular magnetic resonance imaging: detrimental role of right ventricular outflow aneurysms or akinesia and adverse right-to-left ventricular interaction. J Am Coll Cardiol 40:2044–2052PubMedCrossRefGoogle Scholar
  14. 14.
    Ammash NM, Dearani JA, Burkhart HM, Connolly HM (2007) Pulmonary regurgitation after tetralogy of Fallot repair: clinical features, sequelae, and timing of pulmonary valve replacement. Congenit Heart Dis 2:386–403PubMedCrossRefGoogle Scholar
  15. 15.
    Perloff JK (2003) Clinical Recognition of Congenital Heart Disease, 5 edn. Saunders, Philadelphia, pp 348–382Google Scholar
  16. 16.
    Perloff JK (2009) Physical examination of heart and circulation. PMPH USA Ltd, Shelton, pp 205–208Google Scholar
  17. 17.
    Bashore TM (2007) Adult congenital heart disease: right ventricular outflow tract lesions. Circulation 115:1933–1947PubMedCrossRefGoogle Scholar
  18. 18.
    Horowitz LN, Simson MB, Spear JF et al (1979) The mechanism of apparent right bundle branch block after transatrial repair of tetralogy of Fallot. Circulation 59:1241–1252PubMedCrossRefGoogle Scholar
  19. 19.
    Gatzoulis MA, Till JA, Somerville J, Redington AN (1995) Mechanoelectrical interaction in tetralogy of Fallot. QRS prolongation relates to right ventricular size and predicts malignant ventricular arrhythmias and sudden death. Circulation 92:231–237PubMedCrossRefGoogle Scholar
  20. 20.
    Steeds RP, Oakley D (2004) Predicting late sudden death from ventricular arrhythmia in adults following surgical repair of tetralogy of Fallot. QJM 97:7–13PubMedCrossRefGoogle Scholar
  21. 21.
    Lammers A, Kaemmerer H, Hollweck R et al (2006) Impaired cardiac autonomic nervous activity predicts sudden cardiac death in patients with operated and unoperated congenital cardiac disease. J Thorac Cardiovasc Surg 132:647–655PubMedCrossRefGoogle Scholar
  22. 22.
    Lang RM, Bierig M, Devereux RB et al (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463PubMedCrossRefGoogle Scholar
  23. 23.
    Silversides CK, Veldtman GR, Crossin J et al (2003) Pressure half-time predicts hemodynamically significant pulmonary regurgitation in adult patients with repaired tetralogy of fallot. J Am Soc Echocardiogr 16:1057–1062PubMedCrossRefGoogle Scholar
  24. 24.
    Lu JC, Cotts TB, Agarwal PP et al (2010) Relation of right ventricular dilation, age of repair, and restrictive right ventricular physiology with patient-reported quality of life in adolescents and adults with repaired tetralogy of fallot. Am J Cardiol 106:1798–1802PubMedCrossRefGoogle Scholar
  25. 25.
    Gatzoulis MA, Clark AL, Cullen S (1995) Right ventricular diastolic function 15 to 35 years after repair of tetralogy of Fallot. Restrictive physiology predicts superior exercise performance. Circulation 91:1775–1781PubMedCrossRefGoogle Scholar
  26. 26.
    Marie PY, Marcon F, Brunotte F et al (1992) Right ventricular overload and induced sustained ventricular tachycardia in operatively “repaired” tetralogy of Fallot. Am J Cardiol 69:785–789PubMedCrossRefGoogle Scholar
  27. 27.
    Carvalho JS, Shinebourne EA, Busst C (1992) Exercise capacity after complete repair of tetralogy of Fallot: deleterious effects of residual pulmonary regurgitation. Br Heart J 67:470–473PubMedCrossRefGoogle Scholar
  28. 28.
    Wessel HU, Cunningham WJ, Paul MH et al (1980) Exercise performance in tetralogy of Fallot after intracardiac repair. J Thorac Cardiovasc Surg 80:582–593PubMedGoogle Scholar
  29. 29.
    Kang IS, Redington AN, Benson LN et al (2003) Differential regurgitation in branch pulmonary arteries after repair of tetralogy of Fallot: a phase-contrast cine magnetic resonance study. Circulation 107:2938–2943PubMedCrossRefGoogle Scholar
  30. 30.
    Kilner PJ, Geva T, Kaemmerer H et al (2010) Recommendations for cardiovascular magnetic resonance in adults with congenital heart disease from the respective working groups of the European Society of Cardiology. Eur Heart J 31:794–805PubMedCrossRefGoogle Scholar
  31. 31.
    Maceira AM, Prasad SK, Khan M, Pennell DJ (2006) Reference right ventricular systolic and diastolic function normalized to age, gender and body surface area from steady-state free precession cardiovascular magnetic resonance. Eur Heart J 27:2879–2888PubMedCrossRefGoogle Scholar
  32. 32.
    Knauth AL, Gauvreau K, Powell AJ et al (2008) Ventricular size and function assessed by cardiac MRI predict major adverse clinical outcomes late after tetralogy of Fallot repair. Heart 94:211–216PubMedCrossRefGoogle Scholar
  33. 33.
    Therrien J, Siu SC, Harris L et al (2001) Impact of pulmonary valve replacement on arrhythmia propensity late after repair of tetralogy of Fallot. Circulation 103:2489–2494PubMedCrossRefGoogle Scholar
  34. 34.
    Harrild DM, Berul CI, Cecchin F et al (2009) Pulmonary valve replacement in tetralogy of Fallot: impact on survival and ventricular tachycardia. Circulation 119:445–451PubMedCrossRefGoogle Scholar
  35. 35.
    Eicken A, Ewert P, Hager A et al (2011) Percutaneous pulmonary valve implantation: two-centre experience with more than 100 patients. Eur Heart J 32:1260–1265PubMedCrossRefGoogle Scholar
  36. 36.
    Apitz C, Webb GD, Redington AN (2009) Tetralogy of Fallot. Lancet 374:1462–1471PubMedCrossRefGoogle Scholar
  37. 37.
    Buechel ER, Dave HH, Kellenberger CJ et al (2005) Remodelling of the right ventricle after early pulmonary valve replacement in children with repaired tetralogy of Fallot: assessment by cardiovascular magnetic resonance. Eur Heart J 26:2721–2727PubMedCrossRefGoogle Scholar
  38. 38.
    Henkens IR, van Straten A, Schalij MJ et al (2007) Predicting outcome of pulmonary valve replacement in adult tetralogy of Fallot patients. Ann Thorac Surg 83:907–911PubMedCrossRefGoogle Scholar
  39. 39.
    Therrien J, Provost Y, Merchant N (2005) Optimal timing for pulmonary valve replacement in adults after tetralogy of Fallot repair. Am J Cardiol 95:779–782PubMedCrossRefGoogle Scholar
  40. 40.
    Oosterhof T, van Straten A, Vliegen HW et al (2007) Preoperative thresholds for pulmonary valve replacement in patients with corrected tetralogy of Fallot using cardiovascular magnetic resonance. Circulation 116:545–551PubMedCrossRefGoogle Scholar
  41. 41.
    Frigiola A, Tsang V, Bull C et al (2008) Biventricular response after pulmonary valve replacement for right ventricular outflow tract dysfunction: is age a predictor of outcome? Circulation 118(14 Suppl):S182–190PubMedCrossRefGoogle Scholar
  42. 42.
    Warnes CA, Williams RG, Bashore TM et al (2008) ACC/AHA 2008 Guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). Circulation 118:e714–833PubMedCrossRefGoogle Scholar
  43. 43.
    Silversides CK, Kiess M, Beauchesne L et al (2010) Canadian Cardiovascular Society 2009 Consensus Conference on the management of adults with congenital heart disease: outflow tract obstruction, coarctation of the aorta, tetralogy of Fallot, Ebstein anomaly and Marfan's syndrome. Can J Cardiol 26:e80–97PubMedCrossRefGoogle Scholar
  44. 44.
    Baumgartner H, Bonhoeffer P, De Groot NM et al (2010) ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J 31:2915–2957PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2012

Authors and Affiliations

  1. 1.Department of Pediatric Cardiology and Congenital Heart Disease, German Heart CenterTechnical University of MunichMunichGermany

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