Pulmonary valve replacement long after repair of tetralogy of Fallot

Purpose: Pulmonary valve replacement long after repair of tetralogy of Fallot can improve cardiac function, functional status, and arrhythmia propensity. This has not been reported in Japan. We aim to evaluate the effects of pulmonary valve replacement in repaired tetralogy of Fallot. Methods: Nineteen patients underwent pulmonary valve replacement after repair of tetralogy of Fallot, excluding Rastelli type operation, between August 1981 and August 2011. The results of the pulmonary valve replacement were assessed by analyzing preoperative and postoperative cardiothoracic ratio, cardiac function, functional status, QRS duration and durability of the prosthetic valves. Results: There were neither operative nor late deaths. The Cardiothoracic ratio significantly improved from 61.0 ±5.2% preoperatively to 56.2 ± 4.8% postoperatively (P<0.001). The New York Heart association functional class significantly improved from 2.4 ± 0.8 preoperatively to 1.2 ± 0.4 postoperatively as well. Left ventricular ejection fraction showed significant improvement. QRS duration showed significant reduction. The freedom redo pulmonary valve replacement at 20 years was 100%. Conclusion: Pulmonary valve replacement long after repair of previous tetralogy of Fallot had clinical benefits with low mortality. We recommend bioprosthesis for pulmonary valve replacement when adult-sized valve can be accommodated.