{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:01:05Z","timestamp":1766102465806,"version":"3.48.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Italian Ministry of Health with Current Research"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Pulmonary valve replacement (PVR) in patients with repaired tetralogy of Fallot (rTOF) is performed to preserve right ventricular (RV) function and improve exercise capacity. The effects of PVR extend beyond the RV, influencing left ventricular (LV) performance through biventricular interdependence. This study aimed to evaluate the rate of structural and functional ventricular adaptation after PVR, with a focus on risk stratification and clinical management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We prospectively enrolled 74 patients with rTOF who underwent surgical PVR at Bambino Ges\u00f9 Paediatric Hospital. The mean age at initial repair was 0.8 years and at PVR 17.2 years; mean body surface area 1.74 m2. Cardiovascular magnetic resonance (CMR) and cardiopulmonary exercise testing (CPET) were performed preoperatively, 6 months after surgery, and at midterm follow-up (median 57 months). Morphological and functional changes were assessed with ANOVA, and correlations between ventricular parameters were analysed. Receiver-operating-characteristic (ROC) curves identified thresholds for RV normalization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Indexed RV end-diastolic volume (RVEDVi) decreased from 166.8\u2009\u00b1\u200930.1 mL\/m2 (95% confidence interval [CI] 162.5-171.1) to 121.1\u2009\u00b1\u200922.4 mL\/m2 (95% CI 117.0-125.2) postoperatively and 130.2\u2009\u00b1\u200923.5 mL\/m2 (95% CI 126.1-134.3) at follow-up. Indexed RV end-systolic volume (RVESVi) decreased from 85.7\u2009\u00b1\u200921.5 mL\/m2 (95% CI 81.2-90.2) to 56.1\u2009\u00b1\u200914.9 mL\/m2 (95% CI 52.6-59.6) and 61.9\u2009\u00b1\u200916.3 mL\/m2 (95% CI 58.1-65.7). RV ejection fraction improved from 49.2% (95% CI 47.3-51.1) to 55.6% (95% CI 53.6-57.6). ROC analysis identified pre-operative cut-offs RVEDVi \u2264 157.5 mL\/m2 and RVESVi \u2264 68.5 mL\/m2 for RV normalization (AUC 0.871 [95% CI 0.76-0.98]; 0.822 [95% CI 0.71-0.92]). Strong pre-operative correlations between RV and LV volumes (r\u2009=\u20090.79, P\u2009&amp;lt;\u2009.001) persisted post-operatively, with a new correlation between right ventricular ejection fraction [RVEF] and left ventricular ejection fraction [LVEF] (r\u2009=\u20090.65, P\u2009&amp;lt;\u2009.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PVR leads to immediate and sustained RV reverse remodelling, with improved systolic function and reinforced biventricular coupling. Early intervention\u2014before RVESVi exceeds 68.5 mL\/m2\u2014offers the best chance for RV normalization. Integrating CMR with CPET provides a multiparametric strategy to optimize timing, patient selection, and long-term follow-up in rTOF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejcts\/ezaf432","type":"journal-article","created":{"date-parts":[[2025,11,29]],"date-time":"2025-11-29T12:57:51Z","timestamp":1764421071000},"source":"Crossref","is-referenced-by-count":0,"title":["Short- and Mid-term Cardiac Ventricular Remodelling After Pulmonary Valve Replacement in Adults With Repaired Tetralogy of Fallot"],"prefix":"10.1093","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8113-6513","authenticated-orcid":false,"given":"Gianluca","family":"Brancaccio","sequence":"first","affiliation":[{"name":"Pediatric Cardiac Surgery Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS , Rome 4-00165,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Letizia","sequence":"additional","affiliation":[{"name":"Pediatric Cardiac Surgery Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS , Rome 4-00165,","place":["Italy"]},{"name":"Department of Cardiac Surgery, University \u201cLa Sapienza\u201d of Rome , Rome 00165,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marin","family":"Verrengia","sequence":"additional","affiliation":[{"name":"Pediatric Cardiac Surgery Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS , Rome 4-00165,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veronica","family":"Bordonaro","sequence":"additional","affiliation":[{"name":"Advanced Cardiothoracic Imaging Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS , Rome 00161,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Cafiero","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS , Rome 00165,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo","family":"Trezzi","sequence":"additional","affiliation":[{"name":"Pediatric Cardiac Surgery Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS , Rome 4-00165,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2611-8061","authenticated-orcid":false,"given":"Aurelio","family":"Secinaro","sequence":"additional","affiliation":[{"name":"Advanced Cardiothoracic Imaging Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS , Rome 00161,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chinali","family":"Marcello","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS , Rome 00165,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esposito","family":"Claudia","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS , Rome 00165,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0479-5966","authenticated-orcid":false,"given":"Ugo","family":"Giordano","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS , Rome 00165,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eleonora","family":"Marinari","sequence":"additional","affiliation":[{"name":"Cardiac Anestesiology Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS , Rome 00165,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucia","family":"Manuri","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS , Rome 00165,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Montanaro","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS , Rome 00165,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veronica","family":"Lisignoli","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS , Rome 00165,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio","family":"Miraldi","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University \u201cLa Sapienza\u201d of Rome , Rome 00165,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7201-8136","authenticated-orcid":false,"given":"Mara","family":"Pilati","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS , Rome 00165,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria","family":"D\u2019Inzeo","sequence":"additional","affiliation":[{"name":"Pediatric Cardiac Surgery Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS , Rome 4-00165,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benedetta","family":"Leonardi","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS , Rome 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