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This editorial refers to ‘Preoperative thresholds for mid-to-late haemodynamic and clinical outcomes after pulmonary valve replacement in tetralogy of Fallot’[†][1], by J.P. Bokma et al ., on page 829. Tetralogy of Fallot (TOF) is the most common cyanotic heart defect (CHD), accounting for 3–5% of all infants born with a CHD.1 Survival prospects without intervention are bleak, and <25% of unoperated patients survive to adulthood.2 With the advent of surgical palliation and particularly with intracardiac repair operations, the fate of babies born with TOF has changed dramatically, and survival to adulthood is now the rule.3 Milestones in the treatment of TOF are illustrated in Figure 1 . Adult survivors are, however, not cured, and many are left with residual haemodynamic lesions, with severe pulmonary regurgitation (PR) being the most prevalent, found in more than half of all patients. A landmark paper published by Gatzoulis and colleagues in the year 2000 has found an association between significant PR and the risk of sudden death and sustained ventricular tachycardia.4 Based on this observation, growing interest has arisen in whether alleviating PR by pulmonary valve replacement (PVR) may decrease the risk of adverse outcomes. Figure 1 Milestones in the treatment of tetralogy of Fallot.In this issue of the journal, Bokma and colleagues report their data on remodelling of right ventricular (RV) volumes after PVR in young adults with repaired TOF as measured by cardiac magnetic resonance (CMR) imaging.5 They demonstrate that early RV remodelling after valve replacement is maintained after a median follow-up of 6.3 years in patients who did not require redo valve replacement (7/106 underwent redo PVR during follow-up and … [1]: #fn-2

Tetralogy of Fallot, pulmonary valve replacement, and right ventricular volumes: are we chasing the right target?