Paitent selection: repaired tetralogy of Fallot with severe pulmonic valve regurgitation
Indications for valve replacement can be divided into:
(1) symptomatic (items 1 and 2)
(2) asymptomatic with certain cardiac findings (items 3 to 7)
(3) other hemodynamically important abnormalities (items 8 to 11)
Indications:
(1) symptomatic with significant exercise intolerance due to pulmonic valve regurgitation and right ventricular volume overload
(2) symptomatic from syncope and/or tachyarrhythmias
(3) decreased left and/or right ventricular ejection fraction
(4) right ventricular outflow tract (RVOT) aneurysm
(5) QRS > 140 milliseconds
(6) tachyarrhythmias secondary to right ventricular volume overload
(7) right ventricular dilatation
(7a) right ventricular end-systolic volume (RVESV) > 80 mL per square meter
(7b) right ventricular end-diastolic volume (RVEDV) > 150 mL per square meter
(8) right ventricular outflow tract obstruction and/or severe branch (peripheral) pulmonary stenosis
(9) moderate or severe tricuspid regurgitation
(10) residual shunt with Qp to Qs >= 1.5
(11) need to repair the aortic valve or aortic root dilation
Benefits of valve surgery may include:
(1) better survival
(2) avoidance of other serious complications
(3) better quality of life
