Right ventricular function recovery after repeat surgery in patients with congenital heart disease in adult age
Abstract
Aim: The aim of the study was to assess the effect of timing of repeat surgery in patients with tetralogy of Fallot and significant pulmonary valve insufficiency on right ventricular (RV) function. Method: From January 2007 through April 2010, 22 patients aged 16-65 years had repeat surgery at 22.8?+-?7.0 years since primary surgical correction.
The diagnosis and indication criteria were based on the results of echocardiography and ultrasound RV volumetry. The dominant hemodynamic finding was pulmonary valve insufficiency.
All patients had RV dilatation with a diastolic diameter (Dd) of 49.4?+-?8.2 mm, decreased systolic RV function with an ejection fraction (EF) of 44.8?+-?8.8%, RV volume preload with an indexed end-diastolic volume (EDVi) of 192.0?+-?43.8 ml/m2, and an indexed end-systolic volume (ESVi) of 99.2?+-?27.1 ml/m2. Using proximal isovelocity surface area (PISA) method, regurgitation fraction was 58.6?+-?8.4%.
Results: Nineteen patients had pericardial bioprosthesis implantation in the pulmonary position. There was no death among the surgical patients.
Follow-up ultrasound RV volumetry at one year post-operatively documented regression of RV dilatation to 36.4?+-?3.4 mm and decreases in EDVi to 112.9?+-?23.1 ml/m2 and ESVi to 74.2?+-?20.4 ml/m2. Right ventricular function regression was stationary with an EF of 38.2?+-?8.7%.
Conclusion: Our experience with pulmonary valve replacement because of pulmonary valve insufficiency is satisfactory in terms of regression of RV diastolic and systolic volumes and diastolic diameter. Right ventricular volumes do not become fully normalized, with persisting RV decreased function despite the significant decrease in RV volumes.
These facts make us schedule patients for more timely surgery conceivably resulting in faster postoperative RV recovery.