Atrial Fibrillation — EECC MCQ

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HardCardiologyAtrial FibrillationEECC

An adult with repaired tetralogy of Fallot has severe pulmonary regurgitation, RV end-diastolic volume index 172 mL/m², progressive RV dilatation and declining exercise capacity. What management should be considered?

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Correct answer: D — Pulmonary valve replacement assessment in an adult congenital Heart Team

Severe pulmonary regurgitation after tetralogy repair can cause progressive RV dilatation, arrhythmia and irreversible dysfunction before overt symptoms. Marked RV enlargement and objective decline should trigger specialist assessment for pulmonary valve replacement, using CMR volumes, QRS duration, ventricular function, symptoms and arrhythmia burden to determine timing. Apply this conclusion only to the clinical circumstances stated, with appropriate specialist review, contraindication checks, shared decision-making and follow-up. Reassess if the physiology, treatment response or competing risk changes. The competing options would require a different haemodynamic profile, diagnosis, procedural indication or risk balance from the one described here.

Reference: 2020 ESC Guidelines for adult congenital heart disease. https://www.escardio.org/guidelines/clinical-practice-guidelines/adult-congenital-heart-disease/