Pulmonary Valve Replacement: Update on Timing and Ventricular Remodelling

Area of Science:

• Cardiology
• Cardiovascular Imaging
• Congenital Heart Disease

Background:

• Chronic pulmonary regurgitation (PR) following tetralogy of Fallot (TOF) repair causes progressive right ventricular (RV) dilation and dysfunction.
• Pulmonary valve replacement (PVR) offers short- to mid-term improvements in RV size and symptoms, but optimal intervention timing remains unclear.

Purpose of the Study:

• To review current evidence on ventricular remodeling post-PVR, focusing on imaging markers.
• To critically evaluate criteria for determining optimal PVR timing.
• To identify gaps in knowledge and suggest future research directions.

Main Methods:

• Review of contemporary evidence on ventricular remodeling after PVR.
• Focus on cardiovascular magnetic resonance (CMR) and echocardiographic markers.
• Appraisal of classic and emerging criteria for PVR timing.

Main Results:

• Meta-analyses confirm reverse remodeling and symptomatic benefits post-PVR.
• No conclusive survival benefit demonstrated; arrhythmic outcomes remain conflicting.
• Classic thresholds (e.g., RVEDVi, RVESVi) and QRS duration are discussed alongside novel markers like fibrosis and strain.

Conclusions:

• PVR effectively addresses PR and improves RV remodeling and symptoms.
• Optimal timing for PVR requires further investigation, balancing risks of late intervention versus early reintervention.
• Future research should focus on prospective studies, advanced imaging, and personalized medicine for PVR timing.