Reversal of Right Ventricular Remodeling After Correction of Pulmonary Regurgitation in Tetralogy of Fallot

In the sheep model with pathophysiologic changes similar to patients with repaired TOF, severe PR leads to fibrotic changes in the RV. Pulmonary valve replacement reverses these fibrotic changes. Early valve replacement led to a quick RV recovery, and in time there was no difference in outcome between early and late valve replacement. These data support the benefit of valve replacement for RV function and suggest that there is a margin in the timing of the surgery. The fibrotic changes correlated well with the circulating biomarker PICP, which can have an added value in the clinical follow-up of patients with repaired TOF. (J Am Coll Cardiol Basic Trans Science 2023;8:301-315) (c) 2023 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Automated summary

In a sheep model with pathophysiologic changes similar to repaired TOF patients, severe pulmonary regurgitation (PR) leads to fibrotic changes in the right ventricle (RV). Pulmonary valve replacement reverses these fibrotic changes. Early valve replacement results in quick RV recovery, and timing of the surgery does not affect the outcome. The fibrotic changes correlate well with the circulating biomarker PICP, which can be useful in clinical follow-up.