TY - JOUR
T1 - Preoperative thresholds for pulmonary valve replacement in patients with corrected tetralogy of Fallot using cardiovascular magnetic resonance
AU - Oosterhof, Thomas
AU - van Straten, Alexander
AU - Vliegen, Hubert W.
AU - Meijboom, Folkert J.
AU - van Dijk, Arie P. J.
AU - Spijkerboer, Anje M.
AU - Bouma, Berto J.
AU - Zwinderman, Aeilko H.
AU - Hazekamp, Mark G.
AU - de Roos, Albert
AU - Mulder, Barbara J. M.
PY - 2007
Y1 - 2007
N2 - Background - To facilitate the optimal timing of pulmonary valve replacement, we analyzed preoperative thresholds of right ventricular ( RV) volumes above which no decrease or normalization of RV size takes place after surgery. Methods and Results - Between 1993 and 2006, 71 adult patients with corrected tetralogy of Fallot underwent pulmonary valve replacement in a nationwide, prospective follow-up study. Patients were evaluated with cardiovascular magnetic resonance both preoperatively and postoperatively. Changes in RV volumes were expressed as relative change from baseline. RV volumes decreased with a mean of 28%. RV ejection fraction did not change significantly after surgery (from 42 +/- 10% to 43 +/- 10%; P=0.34). Concomitant RV outflow tract reduction resulted in a 25% larger decrease of RV volumes. After correction for surgical RV outflow tract reduction, higher preoperative RV volumes (mL/m(2)) were independently associated with a larger decrease of RV volumes (RV end-diastolic volume: beta = 0.41; P <0.001). Receiver operating characteristic analysis revealed a cutoff value of 160 mL/m2 for normalization of RV end-diastolic volume or 82 mL/m(2) for RV end-systolic volume. Conclusions - Overall, we could not find a threshold above which RV volumes did not decrease after surgery. Preoperative RV volumes were independently associated with RV remodeling and also when corrected for a surgical reduction of the RV outflow tract. However, normalization could be achieved when preoperative RV end-diastolic volume was <160 mL/m(2) or RV end-systolic volume was <82mL/m(2)
AB - Background - To facilitate the optimal timing of pulmonary valve replacement, we analyzed preoperative thresholds of right ventricular ( RV) volumes above which no decrease or normalization of RV size takes place after surgery. Methods and Results - Between 1993 and 2006, 71 adult patients with corrected tetralogy of Fallot underwent pulmonary valve replacement in a nationwide, prospective follow-up study. Patients were evaluated with cardiovascular magnetic resonance both preoperatively and postoperatively. Changes in RV volumes were expressed as relative change from baseline. RV volumes decreased with a mean of 28%. RV ejection fraction did not change significantly after surgery (from 42 +/- 10% to 43 +/- 10%; P=0.34). Concomitant RV outflow tract reduction resulted in a 25% larger decrease of RV volumes. After correction for surgical RV outflow tract reduction, higher preoperative RV volumes (mL/m(2)) were independently associated with a larger decrease of RV volumes (RV end-diastolic volume: beta = 0.41; P <0.001). Receiver operating characteristic analysis revealed a cutoff value of 160 mL/m2 for normalization of RV end-diastolic volume or 82 mL/m(2) for RV end-systolic volume. Conclusions - Overall, we could not find a threshold above which RV volumes did not decrease after surgery. Preoperative RV volumes were independently associated with RV remodeling and also when corrected for a surgical reduction of the RV outflow tract. However, normalization could be achieved when preoperative RV end-diastolic volume was <160 mL/m(2) or RV end-systolic volume was <82mL/m(2)
U2 - https://doi.org/10.1161/CIRCULATIONAHA.106.659664
DO - https://doi.org/10.1161/CIRCULATIONAHA.106.659664
M3 - Article
C2 - 17620511
SN - 0009-7322
VL - 116
SP - 545
EP - 551
JO - Circulation
JF - Circulation
IS - 5
ER -