Treatment of Tetralogy of Fallot with Symptomatic Severe Pulmonary Regurgitation
Clinical Scenario
This protocol covers symptomatic patients with Tetralogy of Fallot who have developed severe pulmonary regurgitation or significant right ventricular outflow tract obstruction — a specific subset with distinct management criteria.
Defining Criteria
The scenario is defined by the following findings:
- Symptomatic presentation
- Severe pulmonary regurgitation with regurgitant fraction by CMR >30–40%
- And/or at least moderate right ventricular outflow tract obstruction (peak velocity >3 m/s)
Treatment Approach
The recommended intervention for this scenario involves pulmonary valve replacement. The complete structured protocol — including full decision criteria, procedural guidance, and the complete management pathway — is available via the link below.
Clinical Goals
The primary aims are improvement of symptoms and reduction of right ventricular volume.
References
DOI: 10.1093/eurheartj/ehaa554
- PVRep is recommended in symptomatic patients with severe PR and/or at least moderate RVOTO.
- Regurgitant fraction by CMR >30–40%.
- Peak velocity >3 m/s.
- A recent meta-analysis demonstrated that PVRep can improve symptoms and reduce RV volume, but a survival benefit still needs to be shown.
View source ↗