Abstract
Few topics in adult congenital heart disease have approached the level of scrutiny
bestowed on pulmonary valve replacement (PVR) strategies late after tetralogy of Fallot
(TOF) repair. Despite the successes of primary surgery for TOF, there is a growing
group of adults with residual right ventricular outflow tract and pulmonary valve
dysfunction. Patients with residual chronic pulmonic regurgitation as a consequence
of earlier surgery can later develop symptoms of exercise intolerance and complications
including heart failure, tachyarrhythmias, and sudden cardiac death. Optimal timing
of PVR has sparked debate, which has catalyzed increasing research efforts over the
past decade. Although performance of PVR in the absence of symptoms is currently on
the basis of the rationale that achievement of complete reverse remodelling is highly
desirable, whether this approach results in improvement in patient outcomes in the
long-term has yet to be shown. Surgical PVR and percutaneous pulmonary valve intervention
are different techniques with specific advantages and disadvantages that require careful
consideration for each individual patient, alongside the need for requisite reinterventions
over the course of a patient's lifetime. Criteria pertaining to referral strategies
are ever being refined as newer technologies for percutaneous therapies continue to
evolve. In this article we review the literature surrounding the indications for,
the optimal timing of, and the approaches to pulmonary valve procedures in adults
with previously repaired TOF.
Résumé
Nous avons abordé quelques thèmes sur la cardiopathie congénitale chez l'adulte en
ce qui concerne le niveau d'examen accordé aux stratégies de remplacement valvulaire
pulmonaire (RVP) bien après la correction de la tétralogie de Fallot (TF). En dépit
de la réussite de l'intervention chirurgicale primaire de la TF, de plus en plus d'adultes
montrent un dysfonctionnement résiduel de la chambre de chasse du ventricule droit
et de la valve pulmonaire. Les patients atteints de régurgitation pulmonaire résiduelle
à long terme en raison de l'intervention chirurgicale antérieure peuvent plus tard
présenter des symptômes d'intolérance à l'effort et des complications, y compris l'insuffisance
cardiaque, les tachyarythmies et la mort cardiaque subite. La controverse entourant
le moment optimal du RVP a permis d'accélérer les efforts de recherche au cours de
la dernière décennie. Bien que la performance du RVP en l'absence de symptômes repose
actuellement sur le principe que la réalisation du remodelage inverse complet est
grandement souhaitable, il reste à démontrer si cette approche se traduit par l'amélioration
des résultats cliniques à long terme chez les patients. La chirurgie de RVP et l'intervention
par voie percutanée de la valve pulmonaire sont des techniques différentes ayant des
avantages et des inconvénients propres à chacune qui exigent un examen minutieux de
chacun des patients parallèlement à la nécessité des réinterventions requises au cours
de la vie du patient. Les critères liés aux stratégies d'orientation sont peaufinés
au fur et à mesure que les nouvelles technologies de traitement par voie percutanée
évoluent. Dans le présent article, nous passons en revue la littérature relative aux
indications, au moment optimal et aux approches chirurgicales en matière d'interventions
de la valve pulmonaire chez les adultes ayant déjà subi une correction de la TF.
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Article info
Publication history
Published online: June 26, 2017
Accepted:
June 22,
2017
Received:
March 15,
2017
Footnotes
See page 1146 for disclosure information.
Identification
Copyright
© 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
