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Schulte LJ, Miller PC, Bhat AN, Carvajal-Dominguez HG, Chomat MR, Miller JR, Nath D, Eghtesady P. Evolution of Pulmonary Valve Management During Repair of Tetralogy of Fallot: A 14-year Experience. Ann Thorac Surg 2023; 115:462-469. [PMID: 35779602 DOI: 10.1016/j.athoracsur.2022.05.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/21/2022] [Accepted: 05/25/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The optimal repair strategy for tetralogy of Fallot remains controversial. This report presents a 14-year evolution of management of the pulmonary valve (PV) from transannular patch to valve-sparing repair to neovalve creation using living right atrial appendage tissue. METHODS A retrospective review of 172 consecutive patients undergoing complete repair for TOF between January 2007 and June 2021 was performed. Clinical and follow-up data were analyzed by repair group. Neopulmonary valve (NPV) creation using right atrial appendage tissue was introduced in 2019. Failure of valve-sparing repair was defined as needing reintervention for recurrent right ventricular outflow tract obstruction (RVOTO). RESULTS Median age and weight at repair were 4.9 months and 6 kg, respectively. Median preoperative PV size and z-score were 6.4 mm (5.2-8.3 mm) and -3.2 (-4.1 to -2.1), respectively. Patients who underwent valve-sparing repair had larger PV size and z-score compared with patients who underwent transannular patch procedures (8 mm vs 5.6 mm; -2.1 vs -3.2; both P < .001). There were no hospital mortalities. Overall follow-up was 44 months. At last follow-up, 10% of patients who underwent valve-sparing repair had repeat intervention for recurrent RVOTO. Patients who had failed valve-sparing repair had significantly lower PV z-scores (-2.6 vs -1.9; P = .01). An NPV was used in 8 patients with a median PV z-score of -4 (-4.7 to -3.9). At 6 months, 6 patients (75%) had mild or trivial pulmonary insufficiency after NPV placement. CONCLUSIONS Repair of tetralogy of Fallot is a safe operation with excellent outcomes. Valve-sparing repair avoids right ventricular dilation but may fail for RVOTO at a PV z-score <-2. NPV creation offers an alternative option in patients with a small PV.
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Affiliation(s)
- Linda J Schulte
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri
| | | | - Amrita N Bhat
- Washington University School of Medicine, St Louis, Missouri
| | - Horacio G Carvajal-Dominguez
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri
| | - Michael R Chomat
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine, St Louis Children's Hospital, St Louis, Missouri
| | - Jacob R Miller
- Section of Pediatric Cardiothoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis Children's Hospital, St Louis, Missouri
| | - Dilip Nath
- Section of Pediatric Cardiothoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis Children's Hospital, St Louis, Missouri
| | - Pirooz Eghtesady
- Section of Pediatric Cardiothoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis Children's Hospital, St Louis, Missouri.
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Yi K, Wang D, Xu J, Zhang X, Wang W, Gao J, Wang W, You T, Tian J. Surgical Strategies for Preservation of Pulmonary Valve Function in a Radical Operation for Tetralogy of Fallot: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:888258. [PMID: 35911536 PMCID: PMC9326161 DOI: 10.3389/fcvm.2022.888258] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To evaluate the efficacy and safety of different surgical strategies to preserve pulmonary valve function. Surgical procedures evaluated include intraoperative balloon pulmonary valvuloplasty (IBPV), pulmonary valve reconstruction, and commissurotomy and pulmonary cusp augmentation (PCA) in patients who underwent a radical operation for Tetralogy of Fallot (ToF). Materials and Methods The five databases searched in the current study included the Cochrane Library, PubMed, China National Knowledge Infrastructure, VIP, and WanFang data. A systematic search for control trials was performed in each database from the start date of each database until December 2021. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of included studies. Results A total of 15 retrospective studies with a total number of 1,396 participants were included in this study. In subgroup 1 (IBPV vs. TAP), patients undergoing IBPV had a less degree of regurgitation at 1-2 years after the surgery. The reintervention rate increased in the IBPV group at 5 years. In subgroup 2 (pulmonary valve reconstruction vs. TAP), the degree of regurgitation decreased in the pulmonary valve reconstruction group at 1 month after the surgery. In subgroup 3 (valve-sparing operation vs. TAP), the comparison demonstrated decreased rates for surgical mortality and reintervention at 5-10 years after the surgery. Conclusion We proposed that pulmonary valve function in a radical operation for ToF was preserved. IBPV, pulmonary valve reconstruction, and commissurotomy and PCA can be performed during the surgical procedure based on the developmental status and anatomical characteristics of the right ventricular outflow tract (RVOT), pulmonary valve, and pulmonary artery. Systematic Review Registration [https://www.crd.york.ac.uk/prospero/], identifier [CRD42022300987].
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Affiliation(s)
- Kang Yi
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Department of Cardiovascular Surgery, Gansu Provincial Hospital, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China
| | - Dan Wang
- Department of Geriatric Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Jianguo Xu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Xin Zhang
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China
- The First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Wenxin Wang
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China
- The First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Jie Gao
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China
- The First Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Wei Wang
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China
- The First Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Tao You
- Department of Cardiovascular Surgery, Gansu Provincial Hospital, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou, China
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Fedevych O, Dhannapuneni R, Guerrero R, Lotto A. Native Pulmonary Valve Restoration Late Following Transannular Patch Repair of Tetralogy of Fallot. World J Pediatr Congenit Heart Surg 2021; 12:677-679. [PMID: 33947283 DOI: 10.1177/2150135120981056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present a surgical case of native pulmonary valve (PV) restoration in a 16-year-old boy with a previous history of transannular patch repair of tetralogy of Fallot in infancy. The PV was restored by approximation of split anterior commissure in the presence of developed and pliable leaflets well preserved after initial surgery. Postoperative echocardiogram showed a competent valve with peak velocity of 2.8 m/s. At six-week follow-up, the patient remained well, and echocardiogram demonstrated a competent PV with decreased velocity of 2.1 m/s across it. We encourage a mindful preservation of PV leaflets whenever it is possible at time of initial repair to implement this relatively easy operation to restore PV function later in life.
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Affiliation(s)
- Oleg Fedevych
- Cardiac Services, 4593Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, United Kingdom
| | - Ramana Dhannapuneni
- Cardiac Services, 4593Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, United Kingdom
| | - Rafael Guerrero
- Cardiac Services, 4593Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, United Kingdom
| | - Attilio Lotto
- Cardiac Services, 4593Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, United Kingdom.,Faculty of Health, Liverpool John Moores University, Kingsway House, Liverpool, United Kingdom
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Shimoda T, Mathis BJ, Kato H, Matsubara M, Suzuki Y, Suetsugu F, Hiramatsu Y. Architecture matters: Tissue preservation strategies for tetralogy of Fallot repair. J Card Surg 2021; 36:2836-2849. [PMID: 33908656 DOI: 10.1111/jocs.15584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/11/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Great variability exists in repair strategies for the tetralogy of Fallot. While transannular patching, as introduced by Kirklin, was a breakthrough for primary repair, pulmonary regurgitation and a need for reoperation have led to the development of methods that preserve the natural morphology of the right ventricular outflow tract. METHODS State-of-the-art details of tetralogy of Fallot repair are explained from the standpoint of architectural preservation, especially with regard to sparing native tissue such as the annulus, valve, or infundibulum. Particular attention is given to the latest technical details of each approach, benefits and disadvantages, and any long-term data available. RESULTS The choice of procedure is complex and unique to each case as transannular patching alone may carry long-term pulmonary risks. Modifications that spare the annulus, valves, or infundibulum may thus be essential as preservation of natural morphology has resulted in excellent mid-term results. CONCLUSIONS The complexity of tetralogy of Fallot repair demands constant attention to clinical presentation and vigilance against long-term sequelae. Techniques will continue to improve over time as long-term data guides the refinement of these innovative surgical methods.
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Affiliation(s)
- Tomonari Shimoda
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Bryan J Mathis
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hideyuki Kato
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Muneaki Matsubara
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yasuyuki Suzuki
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Fuminaga Suetsugu
- Department of Cardiovascular Surgery, Suetsugu Clinic , Kitakyushu, Fukuoka, Japan
| | - Yuji Hiramatsu
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Onan IS, Ergün S, Özturk E, Çelik EC, Ayyıldız P, Onan B. Early results of neopulmonary valve creation technique using right atrial appendage tissue. J Card Surg 2020; 35:2640-2648. [PMID: 33043664 DOI: 10.1111/jocs.14860] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Various valve repair techniques have been described for prevention of pulmonary insufficiency (PI) during right ventricular outflow tract (RVOT) reconstruction with transannular patch. Herein, we present the early results of an alternative technique of neopulmonary valve reconstruction using right atrial appendage (RAA) tissue. METHODS Between October 2019 and December 2019, 12 patients with tetralogy of fallot (TOF) (n = 10), TOF-absent pulmonary valve (n = 1) and intact ventricular septum-pulmonary atresia (n = 1) underwent RVOT reconstruction with neopulmonary valve that was created using RAA tissue. Median age and weight of patients were 9.9 months (5 months-14 years) and 9.8 kg (6.2-47), respectively. RESULTS No mortality or major events developed. Postoperative echocardiography revealed none/trace PI in 11 patients and mild PI in 1 patient. Median right ventricle/left ventricle ratio was 0.46 (0.35-0.65) and RVOT gradient was 20 mm Hg (0-30). Median cardiopulmonary bypass and aortic clamping times were 121 minutes (81-178) and 94 minutes (59-138), respectively. Operative times revealed statistically significant learning curve pattern in terms of cardiopulmonary bypass (r2 = .568; P = .005) and aortic clamping times (r2 = .635; P = .002). Median ventilation time, intensive care unit stay, and the length of hospital stay were 6 hours (2-48), 1 days (1-5), and 7 days (4-10), respectively. Longer perfusion time was not correlated with postoperative times. At median 6 months, echocardiography showed none/trivial PI in 11 patients and mild PI in one patient. CONCLUSION Early results showed that neopulmonary valve reconstruction using the RAA tissue may provide a reasonable alternative for RVOT reconstruction with transannular patch. But long-term results are needed.
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Affiliation(s)
- Ismihan S Onan
- Departments of Pediatric Cardiovascular Surgery Istanbul, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Servet Ergün
- Departments of Pediatric Cardiovascular Surgery Istanbul, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Erkut Özturk
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ekin C Çelik
- Department of Cardiovascular Surgery, Antalya Training Hospital, University of Health Sciences Turkey, Antalya, Turkey
| | - Pelin Ayyıldız
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, University of Health Sciences, Istanbul, Turkey
| | - Burak Onan
- Departments of Pediatric Cardiovascular Surgery Istanbul, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, University of Health Sciences Turkey, Istanbul, Turkey
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van der Ven JP, van den Bosch E, Bogers AJ, Helbing WA. Current outcomes and treatment of tetralogy of Fallot. F1000Res 2019; 8:F1000 Faculty Rev-1530. [PMID: 31508203 PMCID: PMC6719677 DOI: 10.12688/f1000research.17174.1] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2019] [Indexed: 01/08/2023] Open
Abstract
Tetralogy of Fallot (ToF) is the most common type of cyanotic congenital heart disease. Since the first surgical repair in 1954, treatment has continuously improved. The treatment strategies currently used in the treatment of ToF result in excellent long-term survival (30 year survival ranges from 68.5% to 90.5%). However, residual problems such as right ventricular outflow tract obstruction, pulmonary regurgitation, and (ventricular) arrhythmia are common and often require re-interventions. Right ventricular dysfunction can be seen following longstanding pulmonary regurgitation and/or stenosis. Performing pulmonary valve replacement or relief of pulmonary stenosis before irreversible right ventricular dysfunction occurs is important, but determining the optimal timing of pulmonary valve replacement is challenging for several reasons. The biological mechanisms underlying dysfunction of the right ventricle as seen in longstanding pulmonary regurgitation are poorly understood. Different methods of assessing the right ventricle are used to predict impending dysfunction. The atrioventricular, ventriculo-arterial and interventricular interactions of the right ventricle play an important role in right ventricle performance, but are not fully elucidated. In this review we present a brief overview of the history of ToF, describe the treatment strategies currently used, and outline the long-term survival, residual lesions, and re-interventions following repair. We discuss important remaining challenges and present the current state of the art regarding these challenges.
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Affiliation(s)
- Jelle P.G. van der Ven
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Eva van den Bosch
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Ad J.C.C. Bogers
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Willem A. Helbing
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
- Department of Pediatrics, Division of Pediatric Cardiology, Radboud UMC - Amalia Children's Hospital, Nijmegen, The Netherlands
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7
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Hickey E, Pham-Hung E, Halvorsen F, Gritti M, Duong A, Wilder T, Caldarone CA, Redington A, Van Arsdell G. Annulus-Sparing Tetralogy of Fallot Repair: Low Risk and Benefits to Right Ventricular Geometry. Ann Thorac Surg 2018; 106:822-829. [DOI: 10.1016/j.athoracsur.2017.11.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 11/03/2017] [Accepted: 11/08/2017] [Indexed: 10/18/2022]
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8
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Kim H, Sung SC, Choi KH, Lee HD, Kim G, Ko H, Lee YS. Long-term results of pulmonary valve annular enlargement with valve repair in tetralogy of Fallot. Eur J Cardiothorac Surg 2018; 53:1223-1229. [DOI: 10.1093/ejcts/ezx497] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 12/13/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hyungtae Kim
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Gyeongsangnam-do, South Korea
| | - Si Chan Sung
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Gyeongsangnam-do, South Korea
| | - Kwang Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Gyeongsangnam-do, South Korea
| | - Hyoung Doo Lee
- Department of Pediatrics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Gyeongsangnam-do, South Korea
| | - Geena Kim
- Department of Pediatrics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Gyeongsangnam-do, South Korea
| | - Hoon Ko
- Department of Pediatrics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Gyeongsangnam-do, South Korea
| | - Young Seok Lee
- Department of Pediatrics, Dong-A University Hospital, Busan, South Korea
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9
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Khan I, Tufail Z, Afridi S, Iqbal M, Khan T, Waheed A. Surgery for Tetralogy of Fallot in Adults: Early Outcomes. Braz J Cardiovasc Surg 2017; 31:300-303. [PMID: 27849302 PMCID: PMC5094420 DOI: 10.5935/1678-9741.20160063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 05/11/2016] [Indexed: 11/28/2022] Open
Abstract
Objective To study the in-hospital outcome of adult patients who had undergone surgical
repair for Tetralogy of Fallot. Methods A retrospective descriptive study was conducted at the Punjab Institute of
Cardiology searching the hospital records. All those adult patients who had
undergone repair for Tetralogy of Fallot from January 2012 to December 2014
were included in the study. All the patients were operated by the same
surgical team. Patients who underwent primary repair as well as those with
previous palliative procedures were included in the study. Thirty days
outcome was studied by recording variables from the database. Data was
analysed using Statistical Package for Social Sciences version 16. Results A total of 80 patients was included in the study, in which there were 48
(60%) male patients and 32 (40%) female patients. Mean age was
21±0.21 years. Those with previous palliation were 15 (18.75%). The
associated problems observed were: atrial septal defect 27 (33.75%), right
aortic arch 30 (37.5%), patent ductus arteriosus 6 (7.5%) and double outlet
right ventricle 3 (3.75%). In-hospital mortality recorded was 7 (8%).
Postoperative complications encountered were low cardiac output syndrome 9
(11.25%), pleural effusion requiring tapping 3 (3.75%), reoperation for
bleeding 3 (3.8%), pulmonary regurgitation (moderate to severe) 20 (25%)
which occurred in the transannular patch group only and atrial arrhythmia 4
(5%). Conclusion A large number of adult patients are still operated for tetralogy of Fallot
in Pakistan. With increasing experience in the technique the mortality and
morbidity is comparable to international literature.
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Affiliation(s)
- Imran Khan
- Punjab Institute of Cardiology, Lahore, Pakistan
| | - Zafar Tufail
- Punjab Institute of Cardiology, Lahore, Pakistan
| | - Saeed Afridi
- Punjab Institute of Cardiology, Lahore, Pakistan
| | - Madiha Iqbal
- Punjab Institute of Cardiology, Lahore, Pakistan
| | - Tipu Khan
- Punjab Institute of Cardiology, Lahore, Pakistan
| | - Abdul Waheed
- Punjab Institute of Cardiology, Lahore, Pakistan
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Said SM, Mainwaring RD, Ma M, Tacy TA, Hanley FL. Pulmonary Valve Repair for Patients With Acquired Pulmonary Valve Insufficiency. Ann Thorac Surg 2016; 101:2294-301. [PMID: 27083251 DOI: 10.1016/j.athoracsur.2016.01.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/27/2015] [Accepted: 01/04/2016] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Sameh M Said
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, California
| | - Richard D Mainwaring
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, California.
| | - Michael Ma
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, California
| | - Theresa A Tacy
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital/Stanford University, Stanford, California
| | - Frank L Hanley
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, California
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Pulmonary valve replacement after repair of tetralogy of Fallot: Evolving strategies. J Thorac Cardiovasc Surg 2016; 151:623-625. [DOI: 10.1016/j.jtcvs.2015.09.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/02/2015] [Indexed: 02/03/2023]
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