Can you tell me what the typical criteria is for replacing a pulmonary valve in a teenager(17yo) s/p TOF/APVS repair? Current valve/conduit is 13 yo, severe insufficiency(47%) but only mildly dilated/hypertrophied RV, RV end-diastolic upper limits of normal, recent DX of VT and currently taking Beta Blocker. Also, blood flow to RPA is 75% and LPA is 25%. Recommendation is watchful waiting.
This is a question that does not have a definite answer, as most cardiologists are individualizing recommendations for a pulmonary valve replacement in Tetralogy of Fallot based on the particular patients issues. The degree of right ventricular enlargement is the most important factor, with RV volumes in excess of 170 ml/m2 felt to be at risk for long term RV dysfunction. If serial MRIs show a drop in RV ejection fraction ( a measure of the heart's contractile function), then that is an indicator. If the patient develops complex arrhythmias like ventriclar tachycardia, that is a factor. If there is progressive exercise intolerance or a negative change in objective exercise testing, that is a factor. In most situations the patient has to undergo an open heart surgery to replace the pulmonary valve, and then that valve will degenerate with time, usually within 10 years or so. This will then need replacement. At present there is not an FDA approved stent mounted device to put in native outflow tracts during a cardiac catheterization. But if your child has a conduit (tube) between the right ventricle and the pulmonary artery, depending upon its size, they may be a candidate for a Melody valve (stent mounted bioprosthetic valve) that can be placed during a cardiac catheterization. You would need to check with your child's cardiologist to see if that is the case. Your child's new onset of ventricular tachycardia is of concern, and that should be an important factor regarding the timing of an intervention.
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