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

Go to Risk calculators

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.

Progressive decrease in ventricular dysfunction (2a)

≥ 2 of the following (2a)
- RV ESVi > 80 ml/m²
- RVEDV ≥ LVEDV
- RVEF ≤ 46 %
- LVEF ≤ 50%
Progressive decrease in exercise capacity

≥ Moderate progressive functional TR (2b)

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