68
Specific Conditions
Figure 6. Indications for Pulmonary Valve Replacement in
Repaired Tetralogy of Fallot
* Pulmonary valve dysfunction defined as moderate PR (CMR-derived RF ≥25%) or RVSP >2/3
systemic pressure due to RVOTO.
CMR indicates cardiovascular magnetic resonance; ESVi, end-systolic volume index; LVEDV, left
ventricular end-diastolic volume; LVEF, left ventricular ejection fraction; PR, pulmonary regurgitation;
RF, regurgitant fraction; RV, right ventricular; RVEDV, right ventricular end-diastolic volume; RVEF,
right ventricular ejection fraction; RVOTO, right ventricular outflow tract obstruction; RVSP, right
ventricular systolic pressure; TOF, tetralogy of Fallot; and TR, tricuspid regurgitation.
Repaired TOF with
moderate or greater
pulmonary valve
dysfunction*
NO
YES
Symptomatic?
1
Pulmonary valve
replacement
2a
Pulmonary valve
replacement
2a
Pulmonary valve
replacement
Progressive decrease
in ventricular function
≥2 of the following:
• RV ESVi >80 mL/m
2
• RVEDV ≥2× LVEDV
• RVEF ≤46%
• LVEF ≤50%
• Progressive decrease
in exercise capacity
