Table I.
Recommendations for surgical pulmonary valve replacement in asymptomatic patients
| Parameter | ESC Eur Heart J 2010; 31: 2915-57 | AHA J Am Coll Cardiol 2008; 52: e143-263 | CCS Can J Cardiol 2010; 26: e80-97 | New (proposed) Circulation 2013; 128: 1855-7 |
|---|---|---|---|---|
| RVEDVi [ml/m2] | > 160 | ≥ Moderate | > 170 | > 140–150 |
| RVESVi [ml/m2] | ? | ? | ? | > 80 |
| RV dysfunction | Progressive RV dysfunction | ≥ Moderate | ≥ Moderate | RVEF < 47% |
| PS | PG ≥ 80 mm Hg | PG ≥ 50 mm Hg or RV/LV pressure ratio ≥ 0.7 | RV/systemic systolic pressure ≥ 2/3 | RV/systemic systolic pressure ≥ 2/3 |
| PR | Severe | Severe | Free | ≥ Moderate (PRF ≥ 25%) |
| QRS duration [ms] | > 180 | ? | ? | ≥ 140 |
| Arrhythmia | Sustained AT or VT | Symptomatic or sustained AT or VT | AT or VT | Sustained tachyarrhythmia |
| CPET | Decrease | ? | ? | < 60% predicted |
| Other | Significant VSD, AR | Significant VSD | LVEF < 55%, RV/LV EDV > 2, significant VSD, AR, aortic dilation |
ESC – European Society of Cardiology, AHA – American Heart Association, CCS – Canadian Cardiology Society, RVEDVi – right ventricular end-diastolic volume index, RVESVi – right ventricular end-systolic volume index, RV – right ventricle, RVEF – RV ejection fraction, PS – pulmonary stenosis, PG – pulmonary gradient, LV – left ventricle, PR – pulmonary regurgitation, PRF – pulmonary regurgitation fraction, AT – atrial tachyarrhythmia, VT – ventricular tachycardia, CPET – cardiopulmonary exercise test, VSD – ventricular septum defect, AR – aortic regurgitation, EDV – end-diastolic volume.