Echocardiographic Evaluation of Right Ventricular Function After Pulmonary Valve Replacement in Patients With Tetralogy of Fallot

Background: Pulmonary regurgitation is a common complication after tetralogy of Fallot total correction (TFTC). Some of these patients may be candidated for pulmonary valve replacement (PVR) because right ventricular (RV) dysfunction will occur ultimately when a transannular patch has been used. The aims of this study were to evaluate echocardiographic parameters in patients who underwent PVR after TFTC and to determine their outcomes in reference to their preoperative status. Methods: Twenty-six patients with severe pulmonary regurgitation, who underwent PVR after TFTC with the transannular patch in Rajaie Cardiovascular, Medical, and Research Center, were enrolled. Some echocardiographic parameters were assessed before PVR and subsequently 1 and 3 months afterward. Results: Of the echocardiographic parameters, the RV ejection fraction was significantly improved 1 month after PVR (P <0.001), while tricuspid annular plane systolic excursion (TAPSE) was not changed significantly at 1 month postoperatively (P = 0.27). TAPSE and the RV ejection fraction were increased significantly at 3 months postoperatively (P < 0.005). The myocardial performance index (MPI) in both left and right ventricles showed a statistically significant reduction 3 months after PVR (P < 0.001). Conclusions: Our data showed that the RV ejection fraction changed early post PVR, while the changes in the MPI and TAPSE for both ventricles occurred later. Accordingly, these echocardiographic parameters should be evaluated and recorded serially in patients with TFTC. Additionally, these quantitative parameters should be assessed in the follow-up of patients after PVR.