Left Ventricular Function Improves after Pulmonary Valve Replacement in Patients with Previous Right Ventricular Outflow Tract Reconstruction and Biventricular Dysfunction

摘要

Congenital heart defects that have a component of right ventricular outflow tract obstruction, such as tetralogy of Fallot, are frequently palliated in childhood by disruption of the pulmonary valve. Although this can provide an initial improvement in quality of life, these patients are often left with severe pulmonary valve insufficiency. Over time, this insufficiency can lead to enlargement of the right ventricle and to the deterioration of right ventricular systolic and diastolic function. Pulmonary valve replacement in these patients decreases right ventricular volume overload and improves right ventricular performance. To date, few studies have examined the effects of pulmonary valve replacement on left ventricular function in patients with biventricular dysfunction. We sought to perform such an evaluation. Records of adult patients who had undergone pulmonary valve replacement from January 2003 through November 2006 were analyzed retrospectively. We reviewed preoperative and postoperative echocardiograms and calculated left ventricular function in 38 patients. In the entire cohort, the mean left ventricular ejection fraction increased by a mean of 0.07 after pulmonary valve replacement, which was a statistically significant change ( P 1,2 and to worsening RV systolic and diastolic function. 3 Pulmonary valve replacement (PVR) in these patients has been shown to decrease RV volume overload and improve RV performance. 4 Although the optimal timing of PVR has yet to be determined, the improvements in RV health are well documented. Much has been written about the RV after PVR, but data regarding the effect of PVR on the left ventricle (LV) are relatively few. Previous studies have suggested that there is an interaction between right and left ventricular function and that RV dysfunction can result in an unfavorable RV–LV interaction. 5 Conversely, because of this known interaction, improvement in RV performance after PVR could translate into a favorable effect on the LV in patients who have preoperative biventricular dysfunction.