Our Summary

The research paper is about a study conducted on people who had a specific type of heart surgery called Pulmonary Valve Replacement (PVR), which is often done on patients who have a heart condition known as Tetralogy of Fallot (TOF). The study explored the impact of another procedure called Tricuspid Valvuloplasty (TVP), which is done at the same time as PVR in some patients who also have a problem with their tricuspid valve (a condition known as Tricuspid Regurgitation or TR).

The researchers looked at the medical records of patients who had PVR surgery between 2001 and 2012. They found that out of 119 patients with mild to moderate TR, 33 had the TVP procedure at the same time as PVR, while 86 had only the PVR. They found that the TR and the size of the right side of the heart was significantly reduced in both groups.

However, in patients whose new pulmonary valve failed, the TR did not decrease significantly, regardless of whether they had the additional TVP procedure. But in patients whose new pulmonary valve was still working well, the TR was significantly improved in both groups.

The study concluded that while the additional TVP procedure may not prevent TR from reoccurring if the new pulmonary valve fails, it can effectively maintain the function of the tricuspid valve until that happens. The study also found that having moderate TR before the surgery and failure of the new pulmonary valve were significant risk factors for TR reoccurring.

FAQs

  1. What is Pulmonary Valve Replacement (PVR) and why is it performed?
  2. What is the impact of concomitant Tricuspid Valvuloplasty (TVP) on the tricuspid valve function and right ventricle function and size?
  3. What are the significant risk factors for recurrence of significant Tricuspid Regurgitation (TR) after PVR?

Doctor’s Tip

A doctor might tell a patient undergoing pulmonary valve replacement to consider the option of concomitant tricuspid valvuloplasty if they have tricuspid regurgitation at the time of the surgery. This additional procedure may help preserve tricuspid valve function and improve outcomes in the mid-term. However, it is important to note that concomitant tricuspid valvuloplasty may not prevent the recurrence of tricuspid regurgitation if prosthetic pulmonary valve failure occurs. Regular follow-up and monitoring of both the pulmonary and tricuspid valves are essential for long-term success after pulmonary valve replacement.

Suitable For

Patients who are typically recommended for pulmonary valve replacement (PVR) include those with repaired tetralogy of Fallot (TOF) and mild to moderate tricuspid regurgitation (TR) at the time of PVR. Concomitant tricuspid valvuloplasty (TVP) may be considered in patients with TR to improve tricuspid valve function and right ventricle function and size in the mid-term. Patients with preoperative moderate TR and prosthetic PV failure are at a higher risk for recurrence of significant TR after PVR. In patients with preserved prosthetic PV function, TR can be significantly improved after PVR.

Timeline

  • Before pulmonary valve replacement (PVR): The patient may have undergone repair of tetralogy of Fallot (TOF) and developed mild to moderate tricuspid regurgitation (TR). The patient’s tricuspid valve function and right ventricle function and size may have been compromised.

  • During PVR procedure: Some patients may undergo concomitant tricuspid valvuloplasty (TVP) to address TR at the time of PVR. This approach is still controversial.

  • After PVR: Patients experience a significant reduction in TR and right ventricular end-diastolic volume index (RVEDVi) following the procedure. In patients with preserved prosthetic pulmonary valve (PV) function, TR is significantly improved. However, in patients with prosthetic PV failure, there is no significant decrease in TR regardless of concomitant TVP.

  • Long-term outcomes: The recurrence of significant TR after PVR is associated with preoperative moderate TR and prosthetic PV failure. Concomitant TVP may not prevent the recurrence of TR when prosthetic PV failure occurs, but it may effectively preserve tricuspid valve function until that time.

What to Ask Your Doctor

  1. What are the potential risks and complications of undergoing a pulmonary valve replacement surgery?
  2. How will the pulmonary valve replacement impact my overall heart function?
  3. Should I consider having a concomitant tricuspid valvuloplasty during the pulmonary valve replacement surgery?
  4. What are the potential benefits of having a concomitant tricuspid valvuloplasty?
  5. How will the concomitant tricuspid valvuloplasty affect my recovery and long-term outcomes?
  6. What is the likelihood of recurrence of significant tricuspid regurgitation after pulmonary valve replacement with or without concomitant tricuspid valvuloplasty?
  7. How will the pulmonary valve replacement surgery impact my quality of life and physical activity?
  8. How often will I need to follow-up with you after the pulmonary valve replacement surgery?
  9. Are there any specific lifestyle changes or medications I should consider post-surgery?
  10. Are there any additional tests or procedures that I should undergo before or after the pulmonary valve replacement surgery?

Reference

Authors: Min J, Kwak JG, Cho S, Kim ER, Lim JH, Lee CH, Kim WH. Journal: Pediatr Cardiol. 2022 Jan;43(1):74-81. doi: 10.1007/s00246-021-02694-y. Epub 2021 Jul 31. PMID: 34333667