Outcomes after pulmonary valve replacement in patients with repaired tetralogy of Fallot: end of a success story?

Outcomes after pulmonary valve replacement in patients with repaired tetralogy of Fallot: end of a success story?

- in HEALTH
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The success story of sufferers born with tetralogy of Fallot (ToF) is intently linked to vital progress within the remedy of congenital coronary heart illness that resulted in low early mortality and a beneficial course through the first twenty years of life. Consequently, the vast majority of sufferers with repaired ToF survive to maturity and take part in common work and social life. The primary consequence research of bigger cohorts of sufferers, nevertheless, demonstrated a big threat of sudden demise and malignant arrhythmia within the long-term follow-up.1 As a consequence of surgical reduction of proper ventricular (RV) outflow tract obstruction, pulmonary regurgitation (PR) resulted because the predominant, residual haemodynamic lesion inflicting progressive RV enlargement, practical impairment and possibly sudden cardiac demise. Subsequently, pulmonary valve alternative (PVR) was thought of mandatory with a view to abolish valvular insufficiency and to permit reverse remodelling of the dilated RV to regular values. Sadly, as RV volumes and performance didn’t get better in all sufferers and opposed occasions occurred additionally incessantly following PVR, in depth dialogue developed relating to the optimum time level for PVR considering the danger of irreversible RV remodelling versus degeneration of the implanted valve prosthesis over time.

Cardiac MR (CMR) imaging has contributed considerably to the understanding of the pathophysiological penalties of PR resulting from its capability for dependable quantification of PR and volumetric RV evaluation on this inhabitants. Consequently, present suggestions for PVR are largely primarily based on CMR research investigating the impact of PVR on RV …

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