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Erschienen in: General Thoracic and Cardiovascular Surgery 8/2023

16.12.2022 | Original Article

Is the QRS duration useful for determining the optimal timing of pulmonary valve replacement after tetralogy of Fallot repair?

verfasst von: Junya Sugiura, Shunji Uchita, Ai Kojima, Yusuke Akazawa, Hidemi Takata, Masashi Nakamura, Takashi Higaki, Hironori Izutani

Erschienen in: General Thoracic and Cardiovascular Surgery | Ausgabe 8/2023

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Abstract

Objectives

In pulmonary valve replacement (PVR) after tetralogy of Fallot (TOF) repair, the right ventricular end-diastolic and end-systolic volume index (RVEDVI and RVESVI) of cardiac magnetic resonance imaging (cMRI) are often used as indicators of the RV volume. We examined the utility of QRS duration, cardiothoracic ratio (CTR), and plasma brain natriuretic peptide (BNP) as indicators of the appropriate timing of cMRI to assess the RV volume and function before PVR.

Methods

We assessed the correlation of QRS duration, CTR, and BNP with RVEDVI and RVESVI on cMRI in 26 patients after TOF repair. Fifteen underwent PVR (age, 45.2 ± 11.4 years). Twelve underwent post-PVR cMRI. The RV volume change from before to after PVR was investigated.

Results

QRS duration, BNP, and CTR were positively correlated with RVEDVI and RVESVI after TOF repair. The post-PVR QRS duration was also positively correlated with post-PVR RVEDVI (p = 0.017) and RVESVI (p = 0.001). From before to after PVR, in 5 cases with QRS duration ≤ 160 ms, the QRS duration decreased from 110.4 ± 28.9 to 101.8 ± 30.5 ms (p = 0.063). Both RVEDVI and RVESVI decreased to the normal range in 4 of 5 cases. In contrast, in 7 cases with QRS duration > 160 ms, the QRS duration decreased from 183.0 ± 17.4 to 160.3 ± 23.8 ms (p = 0.013); however, RVESVI did not normalize in 6 of 7 cases.

Conclusions

A prolonged QRS duration is a useful marker of RVEDVI and RVESVI enlargement after TOF repair. We recommend performing cMRI before the QRS duration reaches 160 ms due to normalization of the RV volume after PVR.
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Metadaten
Titel
Is the QRS duration useful for determining the optimal timing of pulmonary valve replacement after tetralogy of Fallot repair?
verfasst von
Junya Sugiura
Shunji Uchita
Ai Kojima
Yusuke Akazawa
Hidemi Takata
Masashi Nakamura
Takashi Higaki
Hironori Izutani
Publikationsdatum
16.12.2022
Verlag
Springer Nature Singapore
Erschienen in
General Thoracic and Cardiovascular Surgery / Ausgabe 8/2023
Print ISSN: 1863-6705
Elektronische ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-022-01898-0

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