Patient selection: history of TOF repair
The pulmonary valve should be replaced if the patient has moderate or severe pulmonary regurgitation (as determined by cardiac magnetic resonance) and one or both of the following:
(1) 2 or more of the following:
(1a) right ventricular end-diastolic volume index >= 160 mL per square meter BSA
(1b) right ventricular end-systolic volume index >= 70 mL per square meter BSA
(1c) left ventricular end-diastolic volume index <= 65 mL per square meter BSA
(1d) right ventricular ejection fraction <= 45%
(1e) right ventricular outflow tract (RVOT) aneurysm
(1f) significant cardiac dysfunction (exercise intolerance, heart failure, syncope, sustained ventricular tachycardia, cardiac medications)
(2) a hemodynamically significant lesion (see below) AND clinical indications
(2a) moderate or severe tricuspid regurgitation
(2b) significant residual atrial septal defect
(2c) significant residual ventricular septal defect
(2d) severe aortic regurgitation
If the patient had TOF repair performed when >= 3 years of age, then pulmonary valve replacement may be performed sooner and with less severe dysfunction due to risk for adverse outcomes.
