Prosthetic valve in the pulmonary position, a late complication after total correction of tetralogy of fallot, a new controversial topic in cardiac surgery

Background and context : Pulmonary regurgitation (PR) is the most important residual lesion remaining after repairing tetralogy of Fallot. Through a thorough review of the literature, we attempted to determine the Pathophysiology of chronic right ventricular volume load after tetralogy of Fallot repair .The risks , benefits, indications and timing of pulmonary valve replacement are controversies that we are going to pay attention to them in this article.Materials and Methods: Database search for articles in MEDLINE up to the year 2007, in which. chronic pulmonary valve insufficiency after repaired tetralogy of Fallot had been discussed were selected and if it could have a message regarding the answers to these questions,its message and methodology or results and conclusions were analysed and discussed.Results and data synthesis :18 articles paying attention to the above mentioned questions and controversies were found and their findings are explained and discussed here.Conclusions: Although right ventricular volume load due to severe pulmonary regurgitation after repaired tetralogy of Fallot can be tolerated for years, there is now evidence that the compensatory mechanisms of the right ventricular myocardium ultimately fail and that if the volume load is not eliminated or reduced the dysfunction might be irreversible. In light of that data and with better understanding of risk factors for adverse outcomes late after tetralogy of Fallot repair, many centers are now recommending early pulmonary valve replacement before symptoms of heart failure develop.