Preoperative pulmonary valve annulus diameter z score as a predictor of pulmonary regurgitation after…

Cohort studyJournal of cardiothoracic surgery· Jun 2026

Preoperative pulmonary valve annulus diameter z score as a predictor of pulmonary regurgitation after tetralogy of Fallot repair: a retrospective cohort study.

Pribadi Wiranda Busro, Ahmad Adityawarman, Suprayitno Wardoyo … Oktavia Lilyasari

Congenital Cardiac SurgeryCohort studyPrognosisQ3IF 1.6

Minimal pulmonary annulus z score cutoff of -2.5 was highly specific but insensitive for regurgitation

Preoperative pulmonary valve annulus diameter z score as a predictor of pulmonary regurgitation after tetralogy of Fallot repair: a retrospective cohort study.

Pribadi Wiranda Busro … Oktavia Lilyasari

Journal of cardiothoracic surgery · Jun 2026 · Q3 in Respiratory Medicine

Background

Tetralogy of Fallot (Tetralogy of Fallot) is the most common cause of cyanotic congenital heart disease and pulmonary regurgitation (pulmonary regurgitation) remains its most frequent postoperative complication.

Purpose

This study aimed to determine the predictive value of the preoperative multislice computed tomography-derived pulmonary valve annulus diameter z score for early pulmonary regurgitation after Tetralogy of Fallot repair.

Methods

This retrospective cohort study was conducted using secondary data from pediatric patients who underwent Tetralogy of Fallot repair at the National Cardiac Center Harapan Kita between January 2023 and December 2024.

n = 101 subjects

Results

specificity was high, so a positive result reliably confirms regurgitation risk

Specificity

90.6%

Sensitivity

42%

More results

Both maximal and minimal diameters of the pulmonary valve annulus z scores were associated with moderate or greater pulmonary regurgitation in the univariate analysis (p = 0.001 and p < 0.001, respectively).

More results

However, in multivariate analysis, only transannular patch (transannular patch) remained an independent predictor (p < 0.001), while pulmonary valve annulus z scores were no longer statistically significant.

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Conclusion · 1 of 2

Preoperative pulmonary valve annulus z score is associated with early pulmonary regurgitation but does not independently predict the outcome after adjustment, as its effect is largely mediated by surgical strategy, particularly the use of transannular patch.

Conclusion · 2 of 2

While the proposed cut-off of - 2.5 demonstrates high specificity, its low sensitivity limits its utility as a screening tool.

Preoperative pulmonary valve annulus diameter z score as a predictor of pulmonary regurgitation after tetralogy of Fallot repair: a retrospective cohort study.

Preoperative pulmonary valve annulus diameter z score as a predictor of pulmonary regurgitation after tetralogy of Fallot repair: a retrospective cohort study.

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