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Related Experiment Video

Updated: Feb 14, 2026

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Pulmonary Valve Replacement: Update on Timing and Ventricular Remodelling.

Almudena Ortiz-Garrido1,2, Monika Różewicz Juraszek3, Dominik Daniel Gabbert3,4

  • 1Section of Paediatric Cardiology, Hospital Materno Infantil, Regional Universitario de Málaga, 29011 Malaga, Spain.

Journal of Clinical Medicine
|February 13, 2026
PubMed
Summary

Pulmonary valve replacement (PVR) improves right ventricular (RV) remodeling and symptoms after tetralogy of Fallot (TOF) repair. Optimal PVR timing is still debated, with ongoing research into advanced imaging and personalized strategies.

Keywords:
arrhythmiacardiovascular magnetic resonancefibrosispulmonary regurgitationpulmonary valve replacementright ventricular remodellingtetralogy of Fallottiming of intervention

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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.