Tetralogy of fallot
Indications for pulmonary valve replacement in Repaired Tetralogy of Fallot
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QRS duration ≥ 180 ms
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Moderate or greater LV or RV dysfunction
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Prior ventriculotomy
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Late age at definitive repair
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Symptomatic nonsustained ventricular tachycardia/arrhythmia symptoms
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QRS fragmentation
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Inducible sustained ventricular arrhythmia at invasive electrophysiology study
Indications for pulmonary valve replacement in Repaired Tetralogy of Fallot
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Symptomatic moderate or greater PR (1)
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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)
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RV ESVi > 80 ml/m²
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RVEDV ≥ LVEDV
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RVEF ≤ 46 %
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LVEF ≤ 50%
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Progressive decrease in exercise capacity
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≥ Moderate progressive functional TR (2b)
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Ventricular arrhythmia (2b)
References
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