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Martins RS, Fatimi AS, Mahmud O, Qureshi S, Nasim MT, Virani SS, Tameezuddin A, Yasin F, Malik MA. Comparing clinical and echocardiographic outcomes following valve-sparing versus transannular patch repair of tetralogy of Fallot: a systematic review and meta-analysis. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 39:ivae124. [PMID: 38924512 PMCID: PMC11283307 DOI: 10.1093/icvts/ivae124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/05/2024] [Accepted: 06/25/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES Transannular patch (TAP) repair of tetralogy of Fallot (ToF)relieves right ventricular tract obstruction but may lead to pulmonary regurgitation. Valve-sparing (VS) procedures can avoid this situation, but there is a potential for residual pulmonary stenosis. Our goal was to evaluate clinical and echocardiographic outcomes of TAP and VS repair for ToF. METHODS A systematic search of the PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials and Web of Science databases was carried out to identify articles comparing conventional TAP repair and VS repair for ToF. Random-effects models were used to perform meta-analyses of the clinical and echocardiographic outcomes. RESULTS Forty studies were included in this meta-analysis with data on 11 723 participants (TAP: 6171; VS: 5045). Participants who underwent a VS procedure experienced a significantly lower cardiopulmonary bypass time [mean difference (MD): -14.97; 95% confidence interval (CI): -22.54, -7.41], shorter ventilation duration (MD: -15.33; 95% CI: -30.20, -0.46) and shorter lengths of both intensive care unit (ICU) (MD: -0.67; 95% CI: -1.29, -0.06) and hospital stays (MD: -2.30; 95% CI: [-4.08, -0.52). There was also a lower risk of mortality [risk ratio: 0.40; 95% CI: (0.27, 0.60) and pulmonary regurgitation [risk ratio: 0.35; 95% CI: (0.26, 0.46)] associated with the VS group. Most other clinical and echocardiographic outcomes were comparable in the 2 groups. CONCLUSIONS This meta-analysis confirms the well-established increased risk of pulmonary insufficiency following TAP repair while also demonstrating that VS repairs are associated with several improved clinical outcomes. Continued research can identify the criteria for adopting a VS approach as opposed to a traditional TAP repair.
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Affiliation(s)
- Russell Seth Martins
- Division of Thoracic Surgery, Department of Surgery, Hackensack Meridian School of Medicine and Hackensack Meridian Health Network, Edison, NJ, USA
| | | | - Omar Mahmud
- Medical College, Aga Khan University, Karachi, Pakistan
| | | | | | | | | | - Fatima Yasin
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Mahim Akmal Malik
- Department of Cardiac Surgery, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
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Kadeetham K, Samankatiwat P. Impact of right ventriculotomy on cardiac function after pulmonary valve sparing repair of tetralogy of Fallot and double outlet right ventricle with pulmonary stenosis. Cardiol Young 2024:1-8. [PMID: 38602093 DOI: 10.1017/s1047951124000532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
OBJECTIVES Pulmonary valve-sparing repair of tetralogy of Fallot and double outlet right ventricle with pulmonary stenosis has the advantage of reduced incidence of late pulmonary valve regurgitation and better-preserved cardiac function. However, a right ventriculotomy is sometimes necessary in order to adequately relieve subvalvular pulmonary stenosis. We aimed to compare postoperative cardiac function and patients' symptoms between pulmonary valve-sparing repair with and without right ventriculotomy. MATERIALS AND METHODS We retrospectively collected data from electronic medical records of Ramathibodi Hospital from 1st January 2013 to 31st October 2023. Patients diagnosed with tetralogy of Fallot and double outlet right ventricle with pulmonary stenosis who underwent pulmonary valve-sparing repair were included. Patients who underwent other types of repairs and whose medical record data were significantly missing were excluded. Demographic data, operative, and postoperative details were collected and reviewed. RESULTS There were 49 patients included in our study with 10 patients undergoing pulmonary valve-sparing repair with and the other 39 without right ventriculotomy. Before-discharge echocardiographic parameters were generally similar between both groups (tricuspid annular plane systolic excursion = 0.9 versus 0.89 cm, P = 0.737; pressure gradient across pulmonary valve across pulmonary valve = 24 versus 19 mmHg, P = 0.275; left ventricular end-systolic volume index = 17.84 versus 19.19 ml/m2, P = 0.437; left ventricular end-diastolic volume index = 63.79 versus 61.13 ml/m2, P = 0.436). Patients' symptoms were also not statistically different. There was no early and late death up to the end date of our study. CONCLUSIONS Right ventriculotomy in pulmonary valve-sparing repair did not result in worse postoperative cardiac function and symptoms. This suggested that the previously thought-to-be hazardous incision could be strongly considered if mandated.
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Affiliation(s)
- Khunthorn Kadeetham
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Piya Samankatiwat
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Impact of right ventriculotomy for tetralogy of Fallot repair with a pulmonary valve–sparing procedure. JTCVS OPEN 2022; 9:191-205. [PMID: 36003424 PMCID: PMC9390402 DOI: 10.1016/j.xjon.2021.10.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/19/2021] [Indexed: 11/20/2022]
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Wu M, Fan C, Liu J, Iroegbu CD, Chen W, Huang P, Tang M, Wu X, Wang C, Xiang K, Zhou W, Yang J. Clinical Application of Individualized Pulmonary Bi-Orifice for the Reconstruction of Right Ventricular Outflow Tract in Tetralogy of Fallot. Front Cardiovasc Med 2021; 8:772198. [PMID: 34901232 PMCID: PMC8661005 DOI: 10.3389/fcvm.2021.772198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/31/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: The study aims to establish a new method in the Tetralogy of Fallot (ToF) called the pulmonary valve bi-orifice method (pulmonary annular sparing with an individualized autologous pericardial patch; thus, two orifices are formed at the level of the pulmonary valve annulus) to reconstruct the right ventricular outflow tract (RVOT). Methods: A retrospective analysis of 128 TOF patients from October 2009 to June 2018 with severe pulmonary valve dysplasia who underwent transvalvular annular patch (TAP) procedure (control group) or an individualized pulmonary valve bi-orifice procedure (observation group) were studied. The RVOT for each patient in the observation group was individually reconstructed per the patient's weight and the size of the autologous pulmonary valve using the bi-orifice method; however, increasing the cross-sectional area of the pulmonary valve annulus without destroying its integrity. The result was then compared to the control group, where TAP procedures were applied to evaluate the short to mid-term outcome(s). An in vitro simulation test was used to verify the anti-regurgitation mechanism of the new method. Results: The in vitro simulation test indicated that the anti-regurgitation mechanism was completed by the pericardial patch and the autologous pulmonary valve movement toward each other. Thus, for clinical applications, patients in both groups were compared. The results showed no significant differences in cardiopulmonary bypass and aortic cross-clamp time, mechanical ventilation, and ICU and post-operative residence between the two groups. During the follow-up period (3- to 12-years), 14 patients in the observation group had mild regurgitation after surgery (22.2%), while 10 patients had moderate pulmonary regurgitation (15.8%) with no right ventricular (RV) dilation. On the other hand, 22 patients (39.6%) had moderate to severe regurgitation in the control group, while left pulmonary artery stenosis occurred in one patient. In the control group, six patients (9.2%) with severe RV dilation were reoperated. Conclusion: Individualized pulmonary valve bi-orifice procedure is a safe and excellent method for reconstructing RVOT in ToF.
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Affiliation(s)
- Ming Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Department of the Cardiovascular Surgery, The Hunan Provincial People's Hospital, Changsha, China
| | - Chengming Fan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jian Liu
- Department of Cardiothoracic Surgery, Hunan Children's Hospital, Changsha, China
| | - Chukwuemeka Daniel Iroegbu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wangping Chen
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Peng Huang
- Department of Cardiothoracic Surgery, Hunan Children's Hospital, Changsha, China
| | - Mi Tang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xun Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chunle Wang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Kun Xiang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wenwu Zhou
- Department of the Cardiovascular Surgery, The Hunan Provincial People's Hospital, Changsha, China
| | - Jinfu Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
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Padalino MA, Pradegan N, Azzolina D, Galletti L, Pace Napoleone C, Agati S, Palma G, Marianeschi SM, Seddio F, Cascarano MT, Carro C, Gregori D, Vida VL, Stellin G. The role of primary surgical repair technique on late outcomes of Tetralogy of Fallot: a multicentre study. Eur J Cardiothorac Surg 2021; 57:565-573. [PMID: 31603499 DOI: 10.1093/ejcts/ezz270] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/30/2019] [Accepted: 09/06/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Repair of Tetralogy of Fallot (TOF) has currently excellent results with either transventricular or transatrial approach. However, it is unclear as to which has better late outcomes and what role of residual pulmonary valve (PV) regurgitation in the long term is. We report on late clinical outcomes after repair in a large series of patients with TOF, focusing on the type of surgical technique. METHODS This analysis is a retrospective multicentre study on patients undergoing TOF repair in infancy. The exclusion criteria of the study were TOF with pulmonary atresia or absent PV. RESULTS We selected 720 patients who had undergone TOF repair (median age 5.7 months, interquartile range 3.7-11.7). Preoperative cyanotic spells occurred in 18%. A transatrial repair was performed in 433 (60.1%) patients. The PV was preserved in 249 (35%) patients, while the right ventricular outflow tract was reconstructed with a transannular patch (60.4%) or a conduit (4.6%) in the rest of the patients. At a median follow-up of 4 years (range 1-21, 86% complete), 10 (1.6%) patients died, while 39 (6.3%) patients required surgical reoperation and 72 (11.7%) patients required an interventional procedure. The propensity match analysis showed that the incidence of postoperative complications and adverse events at follow-up were significantly increased in patients undergoing transventricular approach repair with transannular patch (P = 0.006) and PV preservation was a significant protective factor against postoperative complications (P = 0.009, odds ratio 0.5) and late adverse events (P = 0.022). CONCLUSIONS Surgical repair of TOF in infancy is a safe procedure, with good late clinical outcomes. However, transatrial approach and PV preservation at repair are associated with lower early and late morbidity.
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Affiliation(s)
- Massimo A Padalino
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, Padova, Italy
| | - Nicola Pradegan
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, Padova, Italy
| | - Danila Azzolina
- Biostatistics, Epidemiology and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Lorenzo Galletti
- Department of Cardiovascular Surgery, Giovanni XXIII Hospital, Bergamo, Italy
| | - Carlo Pace Napoleone
- Division of Pediatric Cardiac Surgery, Regina Margherita Hospital, Torino, Italy
| | - Salvatore Agati
- Division of Cardiac Surgery, Centro Mediterraneo, Taormina, Italy
| | - Gaetano Palma
- Department of Cardiovascular Surgery, University of Napoli Federico II, Napoli, Italy
| | | | - Francesco Seddio
- Department of Cardiovascular Surgery, Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Cristina Carro
- Division of Pediatric Cardiac Surgery, Ca Granda Niguarda Hospital, Milano, Italy
| | - Dario Gregori
- Biostatistics, Epidemiology and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Vladimiro Lorenzo Vida
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, Padova, Italy
| | - Giovanni Stellin
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, Padova, Italy
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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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Jiang X, Liu J, Peng B, Zhang H, Li S, Yan J, Wang Q. Impact of Annulus-Sparing on Surgical Adequacy of Pulmonary Valve in Complete Repair of Tetralogy of Fallot with Right Ventricular Outflow Tract Incision. Pediatr Cardiol 2021; 42:379-388. [PMID: 33156379 DOI: 10.1007/s00246-020-02493-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/30/2020] [Indexed: 11/24/2022]
Abstract
Today, strategy of repair remains controversial and rare analyses on annular integrity associated with outcomes in complete repair by RVOT incision were performed in a large TOF cohort in China. This is a retrospective cohort study involving patients with TOF who had undergone complete repair by RVOT incision between January 2012 and December 2017 in Fuwai hospital. The primary outcome was a composite of reintervention, significant pulmonary regurgitation (PR) and significant annular peak gradient (APG). Multivariate Cox proportional-hazards model analyses were used to assess the relationships between annular integrity and outcomes. In total, 1673 survival patients with the median age of 318 days were included, and 1002 were male. During a median follow-up of 49 months, 538 participants developed the primary outcome (27 reinterventions). Multivariate Cox analyses showed that compared with AS, TAP was associated with an increased risk of primary outcome (adjusted HR, 1.94 [95% CI 1.60-2.37]) and the results remained unchanged even in most subgroups defined. In secondary outcomes analyses, TAP is associated with a higher risk of reintervention (adjusted HR, 3.32 [95% CI 1.25-8.79]) and significant PR (adjusted HR, 2.51 [95% CI 2.00-3.16]). However, TAP is not associated with a decreased risk of significant APG (adjusted HR, 1.33 [95% CI 0.94-1.88]). PVA integrity preservation is important in complete repair of TOF with RVOT incision. TAP is associated with a higher risk of reintervention and significant PR, and with a similar risk of significant APG. Significant APG in AS patients at discharge has a downtrend over time.
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Affiliation(s)
- Xianchao Jiang
- Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A, Beilishilu, Xi Cheng District, Beijing, China
| | - Jinyang Liu
- Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A, Beilishilu, Xi Cheng District, Beijing, China
| | - Bo Peng
- Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A, Beilishilu, Xi Cheng District, Beijing, China
| | - Heng Zhang
- Department of Cardiac Surgery, Yunnan Fuwai Cardiovascular Hospital, Kunming, China
| | - Shoujun Li
- Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A, Beilishilu, Xi Cheng District, Beijing, China
| | - Jun Yan
- Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A, Beilishilu, Xi Cheng District, Beijing, China
| | - Qiang Wang
- Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A, Beilishilu, Xi Cheng District, Beijing, China. .,Department of Cardiac Surgery, Yunnan Fuwai Cardiovascular Hospital, Kunming, China.
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Fallot-Tetralogie – Update. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2020. [DOI: 10.1007/s00398-020-00385-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Corno AF. Valve-sparing in tetralogy of Fallot: how to open the pulmonary valve. Asian Cardiovasc Thorac Ann 2019; 27:710-712. [PMID: 31500442 DOI: 10.1177/0218492319876189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pulmonary valve stenosis is characterized by high attachment of the commissures to the pulmonary arterial wall. Thus, the tethering of the fused leaflets should be separated from their anomalous insertion, with increased leaflet mobilization in each commissure, and the fusion between the leaflets should be incised until reaching the pulmonary annulus, providing complete opening of the pulmonary valve. This extended opening of pulmonary valve tethering can provide an additional increase of a few millimeters in the diameter of the pulmonary annulus, enough to completely relieve right ventricular outflow tract obstruction without creating pulmonary valve regurgitation.
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Affiliation(s)
- Antonio F Corno
- East Midlands Congenital Heart Center, Glenfield Hospital, Leicester, UK
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Arya A, Srivastava NK, Pande S, Tripathi S, Agarwal SK, Tewari P, Kapoor A. Assessment of untreated fresh autologous pericardium as material for construction of heart valve: Result at 5 years. Ann Card Anaesth 2019; 22:273-277. [PMID: 31274488 PMCID: PMC6639893 DOI: 10.4103/aca.aca_50_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Tetralogy of Fallot requiring transannular repair of the right ventricular outflow tract (RVOT) are exposed to free pulmonary insufficiency and hence inevitable right ventricular dysfunction. This study analyzes the function and structure of untreated autologous pericardium monocusp used to create a competent pulmonary valve. Materials and Methods This is a retrospective analysis of 52 cases operated between December 2006 and December 2012. Untreated autologous pericardium was used for creating a competent pulmonary valve following a transannular patch. They are followed for functional and structural assessment of the pulmonary valve by echocardiography. Positron emission tomography (PET) with 18 fluorodeoxyglucose was performed in two cases for profiling the pulmonary valve. Results Median age was 10.5 years (1-38). The follow-up was complete for 42 (80.76%) patients for 3 years and 25 (48.07%) patients for 5 years. The RVOT gradient was 42 mmHg (16-96) in the year of surgery, which reduced to 26 mmHg (10-58) and pulmonary insufficiency that was present in 8.3% of patients in 1st year was witnessed in 22.7% in the 5th year of follow-up. The monocusp patch was successful in creating a competent valve while maintaining its structure at 3 years; however, it became distorted and retracted at 5 years of follow-up. There was no calcification in any of the patients. PET-computed tomography confirmed the uptake of glucose by monocusp at 1 year of follow-up. Conclusion The untreated autologous pericardium functioned well when it was used to create a competent pulmonary valve at short term and midterm. Although it changed in its structure; there was no calcification at 5 years of follow-up.
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Affiliation(s)
- Amitabh Arya
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Navneet Kumar Srivastava
- Department of Cardiovascular and Thoracic Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shantanu Pande
- Department of Cardiovascular and Thoracic Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shashank Tripathi
- Department of Cardiovascular and Thoracic Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Surendra Kumar Agarwal
- Department of Cardiovascular and Thoracic Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Prabhat Tewari
- Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Aditya Kapoor
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Sinha R, Gooty V, Jang S, Dodge-Khatami A, Salazar J. Validity of Pulmonary Valve Z-Scores in Predicting Valve-Sparing Tetralogy Repairs-Systematic Review †. CHILDREN-BASEL 2019; 6:children6050067. [PMID: 31060236 PMCID: PMC6560514 DOI: 10.3390/children6050067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/22/2019] [Accepted: 04/30/2019] [Indexed: 12/01/2022]
Abstract
There is a lack of consensus regarding the preoperative pulmonary valve (PV) Z-score “cut-off” in tetralogy of Fallot (ToF) patients to attempt a successful valve sparing surgery (VSS). Therefore, the aim of this study was to review the available evidence regarding the association between preoperative PV Z-score and rate of re-intervention for residual right ventricular outflow tract (RVOT) obstruction, i.e. successful valve sparing surgery. A systematic search of studies reporting outcomes of VSS for ToF was performed utilizing PubMed, EMBASE, and Scopus databases. Patients with ToF variants such as pulmonary atresia, major aortopulmonary collaterals, absent pulmonary valve, associated atrioventricular septal defect, and discontinuous pulmonary arteries were excluded. Out of 712 screened publications, 15 studies met inclusion criteria. A total of 1091 patients had surgery at a median age and weight of 6.9 months and 7.2 kg, respectively. VSS was performed on the basis of intraoperative PV assessment in 14 out of 15 studies. The median preoperative PV Z-score was −1.7 (0 to −4.9) with a median re-intervention rate of 4.7% (0–36.8%) during a median follow-up of 2.83 years (1.4–15.8 years). Quantitatively, there was no correlation between decreasing preoperative PV Z-scores and increasing RVOT re-intervention rates with a correlation coefficient of −0.03 and an associated p-value of 0.91. In observational studies, VSS for ToF repair was based on intraoperative evaluation and sizing of the PV following complete relief of all levels of obstruction of the RVOT, rather than pre-operative echocardiography derived PV Z-scores.
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Affiliation(s)
- Raina Sinha
- Division of Pediatric and Congenital Cardiac Surgery, UT-Houston McGovern Medical School, Children's Memorial Hermann Hospital, 6431 Fannin Street, MSB 6.264, Houston, TX 77030, USA.
| | - Vasu Gooty
- Division of Pediatric Cardiology, University of Texas Southwestern, Dallas Children's Medical Center, 1935 Medical District Drive, Dallas, TX 75235, USA.
| | - Subin Jang
- Division of Pediatric Cardiac Surgery, University of Minnesota, Masonic Children's Hospital, 2450 Riverside Ave, Minneapolis, MN 55454, USA.
| | - Ali Dodge-Khatami
- Division of Pediatric and Congenital Cardiac Surgery, UT-Houston McGovern Medical School, Children's Memorial Hermann Hospital, 6431 Fannin Street, MSB 6.264, Houston, TX 77030, USA.
| | - Jorge Salazar
- Division of Pediatric and Congenital Cardiac Surgery, UT-Houston McGovern Medical School, Children's Memorial Hermann Hospital, 6431 Fannin Street, MSB 6.264, Houston, TX 77030, USA.
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Kim DH, Lee JH, Choi ES, Park CS, Yun TJ. Optimal Pulmonary Valve Annulus Diameter for Annulus Preservation in Tetralogy of Fallot May Be Far Smaller Than Normal Annulus Size. Semin Thorac Cardiovasc Surg 2019; 31:253-263. [DOI: 10.1053/j.semtcvs.2018.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/30/2018] [Indexed: 11/11/2022]
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Kwak JG, Kim WH, Kim ER, Lim JH, Min J. One-Year Follow-up After Tetralogy of Fallot Total Repair Preserving Pulmonary Valve and Avoiding Right Ventriculotomy. Circ J 2018; 82:3064-3068. [PMID: 30298850 DOI: 10.1253/circj.cj-18-0690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND We reviewed our revised surgical strategy for tetralogy of Fallot (TOF) total correction to minimize early exposure to significant pulmonary regurgitation (PR) and to avoid right ventriculotomy (RV-tomy). Methods and Results: Since February 2016, we have tried to preserve, first, pulmonary valve (PV) function to minimize PR by extensive commissurotomy with annulus saving; and second, RV infundibular function by avoiding RV-tomy. With this strategy, we performed total correction for 50 consecutive patients with TOF until May 2018. We reviewed the early outcomes of 27 of 50 patients who received follow-up for ≥3 months. Mean patient age at operation was 10.2±5.0 months, and mean body weight was 8.8±1.2 kg. The preoperative pressure gradient at the RV outflow tract and the PV z-score were improved at most recent echocardiography from 82.0±7.1 to 26.8±6.4 mmHg, and from -2.35±0.49 to -0.55±0.54, respectively, during 11.1±1.6 months of follow-up after operation. One patient required re-intervention for residual pulmonary stenosis. Twenty-two patients had less than moderate PR (none, 1; trivial, 8; mild, 13), and 5 patients had moderate PR. There was no free or severe PR. CONCLUSIONS At 1-year follow-up, the patients who underwent total TOF correction with our revised surgical strategy had acceptable results in terms of PV function. The preserved PV had a tendency to grow on short-term follow-up.
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Affiliation(s)
- Jae Gun Kwak
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital
| | - Woong-Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital
| | - Eung Re Kim
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital
| | - Jae Hong Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital
| | - Jooncheol Min
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital
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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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15
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Padalino MA, Cavalli G, Albanese SB, Pace Napoleone C, Guariento A, Cascarano MT, Perazzolo Marra M, Vida V, Boccuzzo G, Stellin G. Long-term outcomes following transatrial versus transventricular repair on right ventricular function in tetralogy of Fallot. J Card Surg 2017; 32:712-720. [DOI: 10.1111/jocs.13236] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Massimo A. Padalino
- Section of Pediatric and Congenital Cardiovascular Surgery; Department of Cardiac, Thoracic and Vascular Sciences; University of Padova Medical Italy; Padova Italy
| | - Giacomo Cavalli
- Section of Cardiology; Department of Cardiac, Thoracic and Vascular Sciences; University of Padua; Padua Italy
| | - Sonia B. Albanese
- Unit of Cardiac Surgery; Department of Cardiology and Cardiac Surgery; Bambino Gesù Children's Hospital, IRCCS; Rome Italy
| | - Carlo Pace Napoleone
- Division of Pediatric Cardiac Surgery; Ospedale Infantile Regina Margherita; Turin Italy
| | - Alvise Guariento
- Section of Pediatric and Congenital Cardiovascular Surgery; Department of Cardiac, Thoracic and Vascular Sciences; University of Padova Medical Italy; Padova Italy
| | - Maria Teresa Cascarano
- Division of Pediatric Cardiac Surgery; Ospedale Infantile Regina Margherita; Turin Italy
| | - Martina Perazzolo Marra
- Section of Cardiology; Department of Cardiac, Thoracic and Vascular Sciences; University of Padua; Padua Italy
| | - Vladimiro Vida
- Section of Pediatric and Congenital Cardiovascular Surgery; Department of Cardiac, Thoracic and Vascular Sciences; University of Padova Medical Italy; Padova Italy
| | | | - Giovanni Stellin
- Section of Pediatric and Congenital Cardiovascular Surgery; Department of Cardiac, Thoracic and Vascular Sciences; University of Padova Medical Italy; Padova Italy
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16
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Mainwaring RD, Hanley FL. Tetralogy of Fallot Repair: How I Teach It. Ann Thorac Surg 2016; 102:1776-1781. [DOI: 10.1016/j.athoracsur.2016.09.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 09/22/2016] [Indexed: 10/20/2022]
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17
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Pande S, Sharma JK, Siddartha CR, Bansal A, Agarwal SK, Tewari P, Kapoor A. Fresh Autologous Pericardium to Reconstruct the Pulmonary Valve at the Annulus When Tetralogy of Fallot Requires a Transannular Patch at Midterm. Tex Heart Inst J 2016; 43:207-13. [PMID: 27303235 DOI: 10.14503/thij-14-4609] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Tetralogy of Fallot often requires reconstruction of the right ventricular outflow tract with a transannular patch (TAP), but this renders the pulmonary valve incompetent and eventually leads to right ventricular dysfunction. We retrospectively evaluated the efficacy of a reconstructed pulmonary valve and annulus in 70 patients who underwent, from December 2006 through December 2010, complete correction of tetralogy of Fallot. We divided the 70 patients into 2 groups in accordance with whether they required (n=50) or did not require (n=20) a TAP. We used autologous untreated pericardium to fashion the TAP and to create both an annulus of the correct size and a competent pulmonary valve with native leaflets. We evaluated the efficiency of this procedure both functionally and anatomically. The median age of the patients was 11 years (range, 2-38 yr). There were 56 males, with no significant difference in sexual distribution between groups. The clinical follow-up was 88% for 57.5 months, and the echocardiographic follow-up was 80% for 36 months. There was no significant difference in outflow gradient or in the occurrence of pulmonary insufficiency between the TAP group (none, 31; mild, 12; moderate, 6; and severe, 1) and the No-TAP group (none, 16; moderate, 2; and severe, 2) (P=0.59). Nor was there any thickening or calcification in the constructed valves. We conclude that pulmonary valves constructed of untreated autologous pericardium performed as well as native valves after total tetralogy of Fallot correction at midterm.
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Sen DG, Najjar M, Yimaz B, Levasseur SM, Kalessan B, Quaegebeur JM, Bacha EA. Aiming to Preserve Pulmonary Valve Function in Tetralogy of Fallot Repair: Comparing a New Approach to Traditional Management. Pediatr Cardiol 2016; 37:818-25. [PMID: 26921062 DOI: 10.1007/s00246-016-1355-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 02/09/2016] [Indexed: 11/25/2022]
Abstract
Pulmonary valve (PV) incompetence following transannular patch (TAP) repair of tetralogy of Fallot (TOF) results in long-term morbidity and mortality. Valve-sparing repairs have recently gained recognition; however, they may be associated with residual pulmonary stenosis (PS) in patients with small PV z scores. We sought to determine whether a repair that increases the PV annulus and augments the valve leaflet with a biomaterial would result in annular growth and in longer duration of valve competence compared with TAP. Eighty patients (median age 136 days, range 4-350) who underwent surgical repair of TOF between 2010 and 2014 were included in the study. Patients were divided into three groups based on the PV intervention: balloon dilation/valvotomy (n = 29), valve-sparing transannular repair (VSTAR) (n = 19) and TAP (n = 32). Intraoperative, early postoperative and midterm follow-up echocardiographic data (median 19 months, range 1-59) were obtained. The primary outcomes were the presence and severity of pulmonary regurgitation and/or PS. Compared with TAP, VSTAR patients demonstrated significantly less severe PR with 100 % freedom of severe PR immediately post-op (vs. 0 % in TAP), 60 % at 6 months and 20 % at 20 months. There were no differences in PS between VSTAR and TAP at follow-up. A subgroup analysis of the VSTAR group was performed. PV z scores were calculated and fit to a random effects model. Patient data fit the model closely, predicting a reproducible increase in valve annulus size over time. With better short-term and comparable midterm results, VSTAR may be appropriate for TOF repair in patients with small PV that would conventionally require a TAP.
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Affiliation(s)
- Danielle Gottlieb Sen
- Pediatric Cardiac Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University, New York, NY, USA
- Pediatric Cardiac Surgery, New Orleans Children's Hospital, New Orleans, LA, USA
| | - Marc Najjar
- Pediatric Cardiac Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University, New York, NY, USA
| | - Betul Yimaz
- Pediatric Cardiology, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University, New York, NY, USA
- Pediatric Cardiology, Texas Children's Hospital, Houston, TX, USA
| | - Stéphanie M Levasseur
- Pediatric Cardiac Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University, New York, NY, USA
| | - Bindu Kalessan
- Pediatric Cardiac Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University, New York, NY, USA
| | - Jan M Quaegebeur
- Pediatric Cardiac Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University, New York, NY, USA
| | - Emile A Bacha
- Pediatric Cardiac Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University, New York, NY, USA.
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19
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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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20
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Yamagishi M. Right Ventricular Outflow Reconstruction Using a Polytetrafluoroethylene Conduit With Bulging Sinuses and Tricuspid Fan-shaped Polytetrafluoroethylene Valve. ACTA ACUST UNITED AC 2016. [DOI: 10.1053/j.optechstcvs.2017.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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21
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Carminati M, Pluchinotta FR, Piazza L, Micheletti A, Negura D, Chessa M, Butera G, Arcidiacono C, Saracino A, Bussadori C. Echocardiographic assessment after surgical repair of tetralogy of fallot. Front Pediatr 2015; 3:3. [PMID: 25699243 PMCID: PMC4313781 DOI: 10.3389/fped.2015.00003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 01/14/2015] [Indexed: 11/19/2022] Open
Abstract
Surgical correction of tetralogy of Fallot is still one of the most frequently performed intervention in pediatric cardiac surgery, and in many cases, it is far from being a complete and definitive correction. It is rather an excellent palliation that solves the problem of cyanosis, but predisposes the patients to medical and surgical complications during follow-up. The decision-making process regarding the treatment of late sequel is among the most discussed topics in adult congenital cardiology. In post-operative Fallot patients, echocardiography is used as the first method of diagnostic imaging and currently allows both a qualitative observation of the anatomical alterations and a detailed quantification of right ventricular volumes and function, of the right ventricular outflow tract, and of the pulmonary valve and pulmonary arteries. The literature introduced many quantitative echocardiographic criteria useful for the understanding of the pathophysiological mechanisms involving the right ventricle and those have made much more objective any decision-making processes.
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Affiliation(s)
- Mario Carminati
- Department of Pediatric Cardiology and Adult with Congenital Heart Disease, IRCCS San Donato Hospital , Milan , Italy
| | - Francesca R Pluchinotta
- Department of Pediatric Cardiology and Adult with Congenital Heart Disease, IRCCS San Donato Hospital , Milan , Italy
| | - Luciane Piazza
- Department of Pediatric Cardiology and Adult with Congenital Heart Disease, IRCCS San Donato Hospital , Milan , Italy
| | - Angelo Micheletti
- Department of Pediatric Cardiology and Adult with Congenital Heart Disease, IRCCS San Donato Hospital , Milan , Italy
| | - Diana Negura
- Department of Pediatric Cardiology and Adult with Congenital Heart Disease, IRCCS San Donato Hospital , Milan , Italy
| | - Massimo Chessa
- Department of Pediatric Cardiology and Adult with Congenital Heart Disease, IRCCS San Donato Hospital , Milan , Italy
| | - Gianfranco Butera
- Department of Pediatric Cardiology and Adult with Congenital Heart Disease, IRCCS San Donato Hospital , Milan , Italy
| | - Carmelo Arcidiacono
- Department of Pediatric Cardiology and Adult with Congenital Heart Disease, IRCCS San Donato Hospital , Milan , Italy
| | - Antonio Saracino
- Department of Pediatric Cardiology and Adult with Congenital Heart Disease, IRCCS San Donato Hospital , Milan , Italy
| | - Claudio Bussadori
- Department of Pediatric Cardiology and Adult with Congenital Heart Disease, IRCCS San Donato Hospital , Milan , Italy
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22
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Sakamoto K, Ota N, Murata M, Tosaka Y, Ide Y, Tachi M, Ito H, Sugimoto A. Modified Nikaidoh procedure with double-root translocation in a 1-year-old boy. Ann Thorac Surg 2014; 97:1055-7. [PMID: 24580922 DOI: 10.1016/j.athoracsur.2013.04.141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/11/2013] [Accepted: 04/18/2013] [Indexed: 11/25/2022]
Abstract
A 1-year-old boy weighing 10.4 kg underwent successful biventricular repair for transposition of the great arteries, a ventricular septal defect, and a left ventricular outflow tract (LVOT) obstruction with moderate pulmonary stenosis of the bicuspid pulmonary valve (z score of -4.4 for the pulmonary valve) by means of a modified Nikaidoh procedure with double root translocation by use of a valve-spared pulmonary root. The postoperative echocardiogram showed no LVOT obstruction, no aortic valve regurgitation, and mild pulmonary stenosis and pulmonary valve regurgitation. No reintervention has been required during the 6-year follow-up, with annular growth of the pulmonary valve.
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Affiliation(s)
- Kisaburo Sakamoto
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Sizuoka City, Japan.
| | - Noritaka Ota
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Sizuoka City, Japan
| | - Masaya Murata
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Sizuoka City, Japan
| | - Yuko Tosaka
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Sizuoka City, Japan
| | - Yujiro Ide
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Sizuoka City, Japan
| | - Maiko Tachi
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Sizuoka City, Japan
| | - Hiroki Ito
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Sizuoka City, Japan
| | - Ai Sugimoto
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Sizuoka City, Japan
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