Right ventricular remodeling after conduit replacement in patients with corrected tetralogy of Fallot - Evaluation by cardiac magnetic resonance

Purpose: To evaluate the potential for right ventricular reverse remodelling after pulmonary valve replacement using cardiac magnetic resonance imaging, in adults with corrected tetralogy of Fallot and severe pulmonary insufficiency. Material and methods: Ten patients with previous correction of tetralogy of Fallot with severe pulmonary insufficiency accepted for pulmonary valve replacement were evaluated prospectively with cardiac magnetic resonance imaging preoperatively and re-evaluated 10 ± 5 months postoperatively. Follow up for survival was 100% complete with mean of 37 ± 12 months. Results: The preoperative mean indexed right ventricular end-diastolic volume was reduced from 161 ± 33 ml/m ² to 120 ± 23 ml/m ² postoperatively, p < 0.001. The preoperative mean indexed right ventricular stroke volume was reduced from 72 ± 20 ml/m ² to 50 ± 6 ml/m ² postoperatively, p = 0.002. After pulmonary valve replacement, the right ventricular ejection fraction did not change significantly (46% versus 42%, p = 0.337). Pulmonary insufficiency fraction decreased from 49% ± 11 to 1% ± 1 postoperatively, p < 0.001. Conclusions: Pulmonary valve replacement leads to a favourable early reverse remodelling with a reduction in RV volumes and improved function in all patients regardless of their preoperative indexed right ventricular volume.