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Tetralogy of fallot

Indications for pulmonary valve replacement in Repaired Tetralogy of Fallot

  • QRS duration ≥ 180 ms

  • Moderate or greater LV or RV dysfunction

  • Prior ventriculotomy

  • Late age at definitive repair

  • Symptomatic nonsustained ventricular tachycardia/arrhythmia symptoms

  • QRS fragmentation

  • Inducible sustained ventricular arrhythmia at invasive electrophysiology study

Risk Scores for Calculating Risk for Sustained Ventricular Tachycardia/Sudden Cardiac Death in Repaired Tetralogy of Fallot

Indications for pulmonary valve replacement in Repaired Tetralogy of Fallot

  • Symptomatic moderate or greater PR (1)

    • Pulmonary valve dysfunction is defined as moderate PR (CMR-derived RF $25%) or RVSP >2/3 systemic pressure due to RVOTO.

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  • Progressive decrease in ventricular dysfunction (2a)

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  • ≥ 2 of the following (2a)

    • RV ESVi > 80 ml/m²

    • RVEDV ≥ LVEDV

    • RVEF ≤ 46 %

    • LVEF ≤ 50%

  • Progressive decrease in exercise capacity

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  •  ≥ Moderate progressive functional TR (2b)

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  • Ventricular arrhythmia (2b)

References

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1) Writing Committee Members∗, Gurvitz M, Krieger EV, Fuller S, Davis LL, Kittleson MM, et al. 2025 ACC/AHA/HRS/ISACHD/SCAI Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2026 Feb 24;153(8):e115–251. doi:10.1161/CIR.0000000000001402

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