Pulmonary valve reconstruction for acquired pulmonary regurgitation in patients with treated congenital heart disease.OBJECTIVES
 Pulmonary valve regurgitation is a common problem after relief of right ventricular outflow tract obstruction with a transannular patch (TAP).  Pulmonary valve replacement (PVR) with a homograft or xenograft is the routine treatment.  Longevity of biological valves and availability of homografts is limited and alternatives to restore RVOT competence are evaluated.  This study presents intermediate-term results for pulmonary valve reconstruction (PVr) in patients with severe regurgitation.


 We analyzed perioperative data, pre- and postoperative cardiac magnetic resonance (CMR) imaging studies, freedom from valve replacement and risk factors for pulmonary valve dysfunction.


 Underlying diagnosis was tetralogy of Fallot (n = 18, 75%), pulmonary stenosis (n = 5, 20.8%) and double outlet right ventricle post banding procedure (n = 1, 4.2%).  Main (n = 9, 37.5%) and branch pulmonary artery procedures (n = 6, 25%) as well as surgery of the RVOT (n = 16, 30.2%) were often part of the reconstruction.  The mean longevity of the reconstructive surgery was 9.9 years (95% confidence interval: 8.8 - 11.1 years).  CMR before and six months after surgery showed a reduction in regurgitation fraction (41% (33-55) vs. 20% (18-27) p = 0.001) and of indexed right ventricular enddiastolic volume (156ml/m2 (149-175) vs. 116ml/m2 (100-143) p = 0.004).  Peak velocity across the pulmonary valve (CMR) half a year after surgery was 2.0 unchanged.


 CONCLUSIONS
 PVr can be achieved with acceptable intermediate-term results and may delay PVR.
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