While I can’t speak to your specific situation without seeing you in-person, in general, for these types of situations I recommend a formal evaluation by a center specializing in the care of adults with congenital heart disease. The Melody PVR is an excellent alternative to traditional surgery for select patients. Currently, the Melody Valve is only approved for patient who have had previous pulmonary valve replacement surgery due to the smaller size of this valve. Evaluation of the severity of a patient’s pulmonary regurgitation, enlargement of the heart and size of the pulmonary valve area are needed to determine if this therapy would be of help.

Thanks for your question,
Dr. Kogon

While I can’t speak to your specific situation without seeing you in-person, I can give you some general information that should help out:

The initial operation for Tetralogy of Fallot involves: 1) closing a hole in the heart, and 2) enlarging a small pulmonary valve opening. Although this repair works well for many many years, subsequent anatomic and functional problems can arise. Most commonly, the pulmonary valve is leaky (regurgitant), although sometimes it can become narrow (stenotic). If left untreated, this can lead to right heart failure and arrhythmias. The treatment is re-operative surgery and pulmonary valve replacement.

A transvalvular gradient of 160 mmHg is quite high, and usually means there is severe narrowing at the level of the valve. The right ventricle can typically compensate for a period of time, although it is unhealthy for the heart long-term. I would be somewhat concerned about vigorous exercise with this degree of obstruction.

You should consult with/see your physician to get a more detailed workup of your condition. He or she will be able to make an assessment on your current exercise levels and make recommendations based on your specific situation.

Hope this helps,
Dr. Kogon

I had my ToF repair nine months after being born [year removed for patient privacy]. I am now [age removed for patient privacy] and just found out that I will need to have the pulmonary valve replaced. I was informed the “trans-valvular gradient” (I think that was the term) is 160. What does that number tell me? I am very active – I run and dance a lot and I hear the muscle in the chambers of the heart are strong, so I wonder why a gradient of 160 is worrisome. Also, do I need to curtail my running and strenuous exercises now?

Thanks very much.