Timing of Pulmonary Valve Replacement: How Much Can the Right Ventricle Dilate Before it Looses Its Remodeling Potential?

Congenital heart disease patients that develop secondary pulmonary regurgitation require a pulmonary valve replacement (PVR) in their follow-up. The indications for PVR in asymptomatic patients are debated. Most guidelines consider a RV end-diastolic volume (RVEDV) over 150 ml/m 2 as an indication for PVR. We analyzed clinical, echocardiographic and MRI variables of patients that underwent a surgical PVR between September 2006 and February 2013. The included patients were asymptomatic, without pulmonary stenosis and with both pre- and post-surgery MRI. Thirty-five patients (74.3 % males) were included. Mean age at PVR was 25.8 years (SD = 7.18), and weight was 64.5 Kg (SD = 12.03). The main diagnosis was tetralogy of Fallot ( n = 28), pulmonary atresia ( n = 2), primary pulmonary regurgitation ( n = 2) and pulmonary regurgitation after percutaneous treatment ( n = 2). The maximal RVEDV pre-PVR was 267 ml/m 2 , and right ventricular end-systolic volume (RVESV) was 183 ml/m 2 . RV size and function were established by MRI: Pre-PVR Post-PVR p RVEDV (ml/m 2 ) 162 (SD = 39.1) 94 (SD = 23.6)