Tetralogy of Fallot, pulmonary valve replacement, and right ventricular volumes: are we chasing the right target?

The timing of PVR in adults with haemodynamically significant PR after childhood repair of TOF remains one of the major challenges in the care of these patients. Timing solely based on RV volumes may be an oversimplification of a complex issue, particularly in asymptomatic patients. In the absence of valid prospective studies with long follow-up duration over decades, careful individual decision-making is mandatory. Given the relatively small absolute risk of adverse events without PVR, we have to adopt a true long-term perspective in adult patients after childhood TOF repair with the aim of improving lifelong outcomes. To allow the individual patient to make an informed decision, uncertainties must be discussed openly and carefully, including discussions about potential long-term risks, such as the largely unknown risks of repeat redo procedures (with difficult timing) and an increased risk of infective endocarditis. Multicentre and ideally international clinical registrieswith meticulous long-termfollow-up protocols are extremely important for patients with and without PVR as only the careful analysis of such long-term follow-up data will finally allow improvement of our knowledge regarding the best future strategies for adults with TOF under our care. © The Author 2015. For permissions please email: journals.permissions@oup.com.