Variations in right ventricular outflow tract morphology following repair of congenital heart disease: implications for percutaneous pulmonary valve implantation

J Cardiovasc Magn Reson. 2007;9(4):687-95. doi: 10.1080/10976640601187596.


Objective: Our aim was to identify sub-groups of right ventricular outflow tract morphology that would be suitable for percutaneous pulmonary valve implantation and to document their prevalence in our patient population.

Materials and methods: Eighty-three consecutive patients with right ventricular outflow tract dysfunction (5-41 years, 76% tetralogy of Fallot) referred to our center for cardiovascular magnetic resonance were studied. A morphological classification was created according to visual assessment of three-dimensional reconstructions and detailed measurement. Diagnosis, right ventricular outflow tract type, surgical history and treatment outcomes were documented.

Results: Right ventricular outflow tract morphology was heterogeneous; nevertheless, 5 patterns were visually identified. Type I, a pyramidal morphology, was most prevalent (49%) and related to the presence of a transannular patch. Other types (II-V) were seen more commonly in patients with conduits. Two patients had unclassifiable morphology. Ninety-five percent of patients were assigned to the correct morphological classification by visual assessment alone. Percutaneous pulmonary valve implantation was performed successfully in 10 patients with Type II-V morphology and in 1 patient with unclassifiable morphology. Percutaneous implantation was not performed in patients with Type I morphology. Only right ventricular outflow tract diameters < 22 mm in diameter were suitable for the current device.

Conclusions: We have created a morphological classification of the RVOT in patients referred for assessment of RVOT dysfunction. Though only 13% of our patients underwent percutaneous implantation, > 50% of outflow tract morphologies may be suitable for this approach, in particular with the development of new devices appropriate for larger outflow.

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Contrast Media
  • Female
  • Gadolinium DTPA
  • Heart Valve Prosthesis Implantation*
  • Heart Valve Prosthesis*
  • Humans
  • Image Processing, Computer-Assisted
  • Imaging, Three-Dimensional
  • Magnetic Resonance Imaging / methods*
  • Male
  • Odds Ratio
  • Pulmonary Valve / surgery*
  • Retrospective Studies
  • Tetralogy of Fallot / physiopathology
  • Tetralogy of Fallot / surgery
  • Treatment Outcome
  • Ventricular Outflow Obstruction / physiopathology
  • Ventricular Outflow Obstruction / surgery*


  • Contrast Media
  • Gadolinium DTPA