Pulmonary Valve Cusp Augmentation for Pulmonary Regurgitation After Repair of Valvular Pulmonary Stenosis

Trileaflet reconstruction of pulmonary valve for acute pulmonary valve insufficiency

Iatrogenic pulmonary valve insufficiency is a life-threatening complication and its treatment options pose another challenge. Easily accessible mechanical valves have high complication rates. Xenografts and homografts are expensive materials and are not readily accessible in case of emergency. Although monoand bileaflet reconstructions with autologous pericardium in the pediatric population has been reported frequently, trileaflet reconstruction of the pulmonary valve has not been reported in the literature, yet. Herein, we, for the first time, present a case of acute pulmonary valve insufficiency which was treated with the trileaflet reconstruction of the pulmonary valve.

Pulmonary Valve Repair for Patients With Acquired Pulmonary Valve Insufficiency

BACKGROUND

Pulmonary valve (PV) insufficiency is often an acquired condition after treatment for pulmonary stenosis. It is recognized that PV insufficiency has serious deleterious effects. Although surgical replacement of the PV is efficacious, artificial valves inevitably fail and require re-intervention. The purpose of this study was to summarize our experience with PV repair in patients with acquired PV insufficiency.

METHODS

This was a retrospective review of 16 patients with marked PV insufficiency who underwent PV repair. Thirteen of these patients were born with tetralogy of Fallot (TOF) and had undergone a previous transannular patch repair. Three patients were born with critical pulmonary stenosis and had a surgical valvotomy or balloon valvuloplasty.

RESULTS

The 13 patients with TOF had resection of their previously placed transannular patch with re-approximation of the anterior commissure. All 13 patients experienced a marked reduction in the degree of pulmonary insufficiency. None of these patients have experienced any increase in insufficiency during follow-up. The 3 patients with critical pulmonary stenosis had a variety of pathologic findings identified at the surgical procedure. One patient had a large gap between a commissure and underwent closure of that commissure. The second and third patients had torn leaflets repaired with pericardial and Gore-Tex patches (Gore, Inc, Flagstaff, AZ). The degree of PV insufficiency was decreased to mild in all 3 patients. However, 2 of these 3 patients have subsequently had an increase in the degree of pulmonary insufficiency.

CONCLUSIONS

Patients with TOF who underwent a previous transannular patch may be candidates for bicuspidization of their native PV, and the results of this procedure have been quite stable at follow-up. PV repair for torn leaflets was effective in the short term but was less stable over time.