Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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The change of QRS duration after pulmonary valve replacement in patients with repaired tetralogy of Fallot and pulmonary regurgitation

  • Yun, Yuni (Division of Pediatric Cardiology, Department of Pediatrics, Kyungpook National University Children's Hospital, School of Medicine, Kyungpook National University) ;
  • Kim, Yeo Hyang (Division of Pediatric Cardiology, Department of Pediatrics, Kyungpook National University Children's Hospital, School of Medicine, Kyungpook National University) ;
  • Kwon, Jung Eun (Division of Pediatric Cardiology, Department of Pediatrics, Kyungpook National University Children's Hospital, School of Medicine, Kyungpook National University)
  • Received : 2018.07.09
  • Accepted : 2018.10.24
  • Published : 2018.11.15
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Abstract

Purpose: This study aimed to analyze changes in QRS duration and cardiothoracic ratio (CTR) following pulmonary valve replacement (PVR) in patients with tetralogy of Fallot (TOF). Methods: Children and adolescents who had previously undergone total repair for TOF (n=67; median age, 16 years) who required elective PVR for pulmonary regurgitation and/or right ventricular out tract obstruction were included in this study. The QRS duration and CTR were measured pre- and postoperatively and postoperative changes were evaluated. Results: Following PVR, the CTR significantly decreased (pre-PVR $57.2%{\pm}6.2%$, post-PVR $53.8%{\pm}5.5%$, P=0.002). The postoperative QRS duration showed a tendency to decrease (pre-PVR $162.7{\pm}26.4$ msec, post-PVR $156.4{\pm}24.4$ msec, P=0.124). QRS duration was greater than 180 msec in 6 patients prior to PVR. Of these, 5 patients showed a decrease in QRS duration following PVR; QRS duration was less than 180 msec in 2 patients, and QRS duration remained greater than 180 msec in 3 patients, including 2 patients with diffuse postoperative right ventricular outflow tract hypokinesis. Six patients had coexisting arrhythmias before PVR; 2 patients, atrial tachycardia; 3 patients, premature ventricular contraction; and 1 patient, premature atrial contraction. None of the patients presented with arrhythmia following PVR. Conclusion: The CTR and QRS duration reduced following PVR. However, QRS duration may not decrease below 180 msec after PVR, particularly in patients with right ventricular outflow tract hypokinesis. The CTR and ECG may provide additional clinical information on changes in right ventricular volume and/or pressure in these patients.

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References

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