Differences in Right Heart Function After Pulmonary Valve Replacement in Patients With Pulmonary Valve Stenosis Versus Tetralogy of Fallot

There is limited data about the impact of timing of pulmonary valve replacement (PVR) on right heart reverse remodeling in patients with pulmonary regurgitation following intervention for isolated pulmonary valve stenosis (PS). This study compared differences in postprocedural right heart reverse remodeling after early versus late PVR (defined as PVR before versus after attainment of the conservative consensus criteria proposed by Bokma et al, 2018) in patients with prior intervention for PS, using patients with tetralogy of Fallot as the reference group. 

Right atrial reservoir strain and right ventricular free wall strain were measured at baseline, one and three years after PVR. There were 114 patients with PS (early PVR, 87 [76 percent]; late PVR, 27 [24 percent]) and 291 patients with tetralogy of Fallot (early PVR, 197 [67 percent]; late PVR, 96 [33 percent]). The PS group had greater improvement in right atrial reservoir strain at one year (12 percent ±4 percent versus 8 percent±4 percent; P<0.001) and three years (15 percent±6 percent  versus 9 percent ±6 percent ; P<0.001), and a greater improvement in right ventricular free wall strain at one year (12 percent ±4 percent  versus 7 percent ±3 percent , P=0.008) and three years (16 percent ±6 percent  versus 12 percent ±5 percent ; P=0.01) after PVR compared with the tetralogy of Fallot group. There was no difference in right heart reverse remodeling between patients who underwent early versus later PVR within the PS group. In contrast, late PVR was associated with less right heart reverse remodeling within the tetralogy of Fallot group. 

These data suggest that patients with palliated PS presenting pulmonary regurgitation have a more benign clinical course, hence, delaying PVR in this population may be appropriate.