M Yamagishi1, H Kurosawa, K Nomura, N Kitamura. 1. Department of Pediatric Cardiovascular Surgery Children's Research Hospital, Kyoto Prefectura University of Medicine, Kyoto, Japan. myama@koto.kpu-m.ac.jp
Abstract
BACKGROUND: Residual pulmonary insufficiency remains a problem after transannular repair in pediatric patients. We have developed fan-shaped monocuspid and bicuspid valves made of expanded polytetrafluoroethylene (ePTFE) membrane for repair of right ventricular outflow tract obstruction in patients with tetralogy of Fallot. METHODS: We studied 20 patients (mean age, 39.6 months) with tetralogy of Fallot. The right ventricular outflow tract was reconstructed with use of a short, wide transannular patch and a fan-shaped valve made of 0.1-mm-thick expanded ePTFE membrane (PRECLUDE Pericardial Membrane, W.L. Gore & Associates, Inc, Flagstaff, AZ). The width of the valve and the outflow patch were constructed so that the neopulmonary annulus was approximately 130% the normal size. RESULTS: A monocuspid valve was used in 17 patients and a bicuspid valve in 3. The mean follow-up time was 32.3 months (range, 14.7 to 56.7 months). Right ventricular function was well maintained in all patients. Valvular motion remained competent in 13 patients (65%). In the remaining 7 (35%), the valve became fixed in the open position. Trivial and mild pulmonary insufficiency was detected in 10 patients with a competent valve and 7 with an incompetent valve. No pressure gradient across the neopulmonary annulus or calcification of the expanded ePTFE membrane was detected in any patient. CONCLUSIONS: The fan-shaped expanded ePTFE valve is a useful substitute with adequate function in transannular right ventricular outflow reconstruction.
BACKGROUND: Residual pulmonary insufficiency remains a problem after transannular repair in pediatric patients. We have developed fan-shaped monocuspid and bicuspid valves made of expanded polytetrafluoroethylene (ePTFE) membrane for repair of right ventricular outflow tract obstruction in patients with tetralogy of Fallot. METHODS: We studied 20 patients (mean age, 39.6 months) with tetralogy of Fallot. The right ventricular outflow tract was reconstructed with use of a short, wide transannular patch and a fan-shaped valve made of 0.1-mm-thick expanded ePTFE membrane (PRECLUDE Pericardial Membrane, W.L. Gore & Associates, Inc, Flagstaff, AZ). The width of the valve and the outflow patch were constructed so that the neopulmonary annulus was approximately 130% the normal size. RESULTS: A monocuspid valve was used in 17 patients and a bicuspid valve in 3. The mean follow-up time was 32.3 months (range, 14.7 to 56.7 months). Right ventricular function was well maintained in all patients. Valvular motion remained competent in 13 patients (65%). In the remaining 7 (35%), the valve became fixed in the open position. Trivial and mild pulmonary insufficiency was detected in 10 patients with a competent valve and 7 with an incompetent valve. No pressure gradient across the neopulmonary annulus or calcification of the expanded ePTFE membrane was detected in any patient. CONCLUSIONS: The fan-shaped expanded ePTFE valve is a useful substitute with adequate function in transannular right ventricular outflow reconstruction.
Authors: Dong-Hee Kim; Young Kern Kwon; Eun Seok Choi; Bo Sang Kwon; Chun Soo Park; Tae-Jin Yun Journal: Interact Cardiovasc Thorac Surg Date: 2022-09-09