Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-26T12:24:53.284Z Has data issue: false hasContentIssue false
  • English
  • Français

Pulmonary insufficiency: preparing the patient with ventricular dysfunction for surgery

Published online by Cambridge University Press:  08 September 2005

Beatriz Bouzas ,
Anthony C. Chang  and
Michael A. Gatzoulis
Beatriz Bouzas
Affiliation:
Adult Congenital Heart Program, Royal Brompton Hospital, London, United Kingdom
Anthony C. Chang
Affiliation:
Pediatric Cardiology, Texas Children's Hospital, Houston, Texas, United States of America
Michael A. Gatzoulis
Affiliation:
Adult Congenital Heart Program, Royal Brompton Hospital, London, United Kingdom
Get access Rights & Permissions [Opens in a new window]

Extract

Insufficiency of any of the four cardiac valves is a common cause of heart failure in children. Progression of ventricular dysfunction can be predictable, but requires thorough understanding of valvar disease. In valvar regurgitation, the heart has to cope with an increased volume of blood. The pathophysiological sequence is similar for both the right and the left heart. There is initially an increase in end-diastolic volume, followed by an increase in end-systolic volume, and at the end, a decrease in the shortening and ejection fractions. Different compensatory mechanisms and pathophysiologic adaptations develop to maintain the stroke volume for each type of valvar insufficiency, but heart failure eventually ensues. When symptoms of heart failure develop, irreversible ventricular dysfunction is often established, and outcome after surgery may ultimately be compromised. Discerning the optimal time for intervention, before irreversible ventricular dysfunction develops, is a key point in the management of regurgitant valvar heart disease.

Type
PART 2: TETRALOGY OF FALLOT
Information
Cardiology in the Young , Volume 15 , Issue S1 , February 2005 , pp. 51 - 57
Copyright
© 2005 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Based, with permission, on the chapter by Bouzas-Zubeldia B and Gatzoulis MA. “Valvular Insufficiency and Heart Failure” to be published in Chang AC and Towbin JA (eds). Heart Failure in Children and Young Adults: From Molecular Mechanisms to Medical and Surgical Strategies. In press.

References

Westaby S, Katsumata T. Congenital absence of a single pulmonary valve cusp. Ann Thorac Surg 1997; 64: 849–851.Google Scholar
Murphy JG, Gersh BJ, Mair DD, et al. Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot. N Engl J Med 1993; 329: 593–599.Google Scholar
Nollert G, Fischlein T, Bouterwek S, et al. Long-term survival in patients with repair of tetralogy of Fallot: 36-year follow-up of 490 survivors of the first year after surgical repair. J Am Coll Cardiol 1997; 30: 1374–1383.Google Scholar
Davlouros PA, Kilner PJ, Hornung TS, et al. Right ventricular function in adults with repaired tetralogy of Fallot assessed with cardiovascular magnetic resonance imaging: detrimental role of right ventricular outflow aneurysms or akinesia and adverse right-to-left ventricular interaction. J Am Coll Cardiol 2002; 40: 2044–2052.Google Scholar
Chen CR, Cheng TO, Huang T, et al. Percutaneous balloon valvuloplasty for pulmonic stenosis in adolescents and adults. N Engl J Med 1996; 335: 21–25.Google Scholar
Griffith BP, Hardesty RL, Siewers RD, et al. Pulmonary valvulotomy alone for pulmonary stenosis: results in children with and without muscular infundibular hypertrophy. J Thorac Cardiovasc Surg 1982; 83: 577–583.Google Scholar
Hayes CJ, Gersony WM, Driscoll DJ, et al. Second natural history study of congenital heart defects. Results of treatment of patients with pulmonary valvar stenosis. Circulation 1993; 87: I28–I37.Google Scholar
McCrindle BW. Independent predictors of long-term results after balloon pulmonary valvuloplasty. Valvuloplasty and Angioplasty of Congenital Anomalies (VACA) Registry Investigators. Circulation 1994; 89: 1751–1759.Google Scholar
McCrindle BW, Kan JS. Long-term results after balloon pulmonary valvuloplasty. Circulation 1991; 83: 1915–1922.Google Scholar
O'Connor BK, Beekman RH, Lindauer A, Rocchini A. Intermediate-term outcome after pulmonary balloon valvuloplasty: comparison with a matched surgical control group. J Am Coll Cardiol 1992; 20: 169–173.Google Scholar
Laneve SA, Uesu CT, Taguchi JT. Isolated pulmonary valvular regurgitation. Am J Med Sci 1962; 244: 446–458.Google Scholar
Gatzoulis MA, Balaji S, Webber SA, et al. Risk factors for arrhythmia and sudden death in repaired tetralogy of Flalot: a multi-centre study. Lancet 2000; 356: 975–981.Google Scholar
Ilbawi MN, Idriss FS, DeLeon SY, et al. Factors that exaggerate the deleterious effects of pulmonary insufficiency on the right ventricle after tetralogy repair. Surgical implications. J Thorac Cardiovasc Surg 1987; 93: 36–44.Google Scholar
Gatzoulis MA, Clark AL, Cullen S, Newman CG, Redington AN. Right ventricular diastolic function 15 to 35 years after repair of tetralogy of Fallot. Restrictive physiology predicts superior exercise performance. Circulation 1995; 91: 1775–1781.Google Scholar
Carvalho JS, Shinebourne EA, Busst C, Rigby ML, Redington AN. Exercise capacity after complete repair of tetralogy of Fallot: deleterious effects of residual pulmonary regurgitation. Br Heart J 1992; 67: 470–473.Google Scholar
Shimazaki Y, Blackstone EH, Kirklin JW. The natural history of isolated congenital pulmonary valve incompetence: surgical implications. Thorac Cardiovasc Surg 1984; 32: 257–259.Google Scholar
Marie PY, Marcon F, Brunotte F, et al. Right ventricular over-load and induced sustained ventricular tachycardia in operatively “repaired” tetralogy of Fallot. Am J Cardiol 1992; 69: 785–789.Google Scholar
Bousvaros GA, Deuchar DC. The murmur of pulmonary regurgitation which is not associated with pulmonary hypertension. Lancet 1961; 2: 962–964.Google Scholar
Li W, Davlouros PA, Kilner PJ, et al. Doppler-echocardiographic assessment of pulmonary regurgitation in adults with repaired tetralogy of Fallot: Comparison with cardiovascular magnetic resonance imaging. Am Heart J 2004; 147: 165–172.Google Scholar
Goldberg SJ, Allen HD. Quantitative assessment by Doppler echocardiography of pulmonary or aortic regurgitation. Am J Cardiol 1985; 56: 131–135.Google Scholar
Helbing WA, Niezen RA, Le Cessie S, et al. Right ventricular diastolic function in children with pulmonary regurgitation after repair of tetralogy of Fallot: volumetric evaluation by magnetic resonance velocity mapping. J Am Coll Cardiol 1996; 28: 1827–1835.Google Scholar
Helbing WA, de Roos A. Optimal imaging in assessment of right ventricular function in tetralogy of Fallot with pulmonary regurgitation. Am J Cardiol 1998; 82: 1561–1562.Google Scholar
Davos CH, Davlouros PA, Wensel R, et al. Global impairment of cardiac autonomic nervous activity late after repair of tetralogy of Fallot. Circulation 2002; 106: I69–I75.Google Scholar
Bolger AP, Sharma R, Li W, et al. Neurohormonal activation and the chronic heart failure syndrome in adults with congenital heart disease. Circulation 2002; 106: 92–99.Google Scholar
Gatzoulis MA, Elliott JT, Guru V, et al. Right and left ventricular systolic function late after repair of tetralogy of Fallot. Am J Cardiol 2000; 86: 1352–1357.Google Scholar
Yemets IM, Williams WG, Webb GD, et al. Pulmonary valve replacement late after repair of tetralogy of Fallot. Ann Thorac Surg 1997; 64: 526–530.Google Scholar
Oechslin EN, Harrison DA, Harris L, et al. Reoperation in adults with repair of tetralogy of Fallot: indications and outcomes. J Thorac Cardiovasc Surg 1999; 118: 245–251.Google Scholar
Therrien J, Siu SC, Harris L, et al. Impact of pulmonary valve replacement on arrhythmia propensity late after repair of tetralogy of Fallot. Circulation 2001; 103: 2489–2494.Google Scholar
Caldarone CA, McCrindle BW, Van Arsdell GS, et al. Independent factors associated with longevity of prosthetic pulmonary valves and valved conduits. J Thorac Cardiovasc Surg 2000; 120: 1022–1030.Google Scholar
Balaguer JM, Byrne JG, Cohn LH. Orthotopic pulmonic valve replacement with a pulmonary homograft as an interposition graft. J Card Surg 1996; 11: 417–420.Google Scholar
Kawachi Y, Masuda M, Tominaga R, Tokunaga K. Comparative study between St. Jude Medical and bioprosthetic valves in the right side of the heart. Jpn Circ J 1991; 55: 553–562.Google Scholar
Vliegen HW, van Straten A, de Roos A, et al. Magnetic resonance imaging to assess the hemodynamic effects of pulmonary valve replacement in adults late after repair of tetralogy of Fallot. Circulation 2002; 106: 1703–1707.Google Scholar
Warner KG, Anderson JE, Fulton DR, Payne DD, Geggel RL, Marx GR. Restoration of the pulmonary valve reduces right ventricular volume overload after previous repair of tetralogy of Fallot. Circulation 1993; 88: II189–II197.Google Scholar
Bove EL, Kavey RE, Byrum CJ, Sondheimer HM, Blackman MS, Thomas FD. Improved right ventricular function following late pulmonary valve replacement for residual pulmonary insufficiency or stenosis. J Thorac Cardiovasc Surg 1985; 90: 50–55.Google Scholar
Therrien J, Siu SC, McLaughlin PR, Liu PP, Williams WG, Webb GD. Pulmonary valve replacement in adults late after repair of tetralogy of Fallot: are we operating too late? J Am Coll Cardiol 2000; 36: 1670–1675.Google Scholar
Bonhoeffer P, Boudjemline Y, Qureshi SA, et al. Percutaneous insertion of the pulmonary valve. J Am Coll Cardiol 2002; 39: 1664–1669.Google Scholar