Impact of pulmonary valve replacement on left ventricular function in patients with repaired tetralogy of Fallot and severe pulmonary regurgitation: a cross-sectional study

Background and purpose: Surgical repair of tetralogy of Fallot (TOF) in early childhood has dramatically improved survival, with more than 95% of patients reaching adulthood. However, long-term complications such as chronic pulmonary regurgitation (PR) remain prevalent, leading to right ventricular (RV) dilation and dysfunction, and adversely affecting left ventricular (LV) performance. This study aimed to evaluate changes in LV function, specifically left ventricular ejection fraction (LVEF), following pulmonary valve replacement (PVR) in patients with severe PR after TOF repair. Methods: In this cross-sectional study, 216 patients with severe PR who undergone PVR after complete TOF repair were analyzed. Echocardiographic parameters, including LVEF, were assessed pre- and post-operatively. Non-parametric statistical analyses were applied, with significance defined as P < 0.05. Results: Median LVEF improved significantly from 45% preoperatively to 55% postoperatively (P < 0.001). Among the patients, 176 patients (81.5%) exhibited increased LVEF post-PVR, while only two showed a decrease, and 38 showed no change. Subgroup analysis revealed no significant sex-related differences in LVEF improvement. Conclusions: PVR significantly improves LVEF in patients with severe PR following TOF repair, regardless of sex. These findings highlight PVR as a critical intervention for managing TOF-related ventricular dysfunction and support individualized treatment strategies in this population.