Zhongdong Hua1, Shoujun Li, Liqing Wang, Shengshou Hu, De Wang. 1. Pediatric Heart Center, Fuwai Hospital and Cardiovascular Institute, National Center for Cardiovascular Diseases, 167 Beilishi Road, Beijing 10037, People's Republic of China.
Abstract
OBJECTIVES: To assess the operative and mid-term outcome of a very aggressive pulmonary annulus preservation strategy and pulmonary valve leaflet plasty technique which achieved 95% freedom of transannular patch (TAP) in complete tetralogy repair. METHODS: From August 2006 through May 2010, 139 consecutive patients underwent repair of tetralogy of Fallot at a median age of 6.5 months, with median weight 7.2kg. None of the patients had a prior shunt. A total of 132 patients (95%) had pulmonary valve annulus-sparing procedures, predominantly through a transatrial and transpulmonary approach (n=120%, 86.3%). Special techniques included generous pulmonary supra-valve patch, bicuspid pulmonary leaflets plasty, or augmentation to maximally preserve pulmonary annulus. All the patients who survived were followed up closely. RESULTS: Only seven (5.0%) patients had a TAP. Among them, five (71.4%) had doubly committed subarterial defect. None of the tricuspid pulmonary valves need TAP. Preoperative size of pulmonary annulus<-6 is associated with TAP (p<0.001). A total of 12 (13.7%) patients needed repump to do either a ventriculotomy and patch the incision or a TAP to relieve residual stenosis. One patient needed a third pump run to do a TAP. The operative mortality was 0.7%, and there was one late death due to hemoptysis. The pulmonary regurgitation of non-TAP patients was less than mild in 105 (79.5%) and mild to moderate in 27 (20.5%) patients. Three patients had peak gradient greater than 50mmHg across the right ventricle and pulmonary artery at 1-month follow-up, but the gradient dropped to less than 50mmHg in two patients at 6-month follow-up. One patient had a persistent 50-55mmHg gradient across pulmonary valve and he is under close follow-up. CONCLUSIONS: Excellent outcome can be achieved even with 95% freedom of TAP in complete repair of tetralogy. The function of most patients' pulmonary valve was well preserved.
OBJECTIVES: To assess the operative and mid-term outcome of a very aggressive pulmonary annulus preservation strategy and pulmonary valve leaflet plasty technique which achieved 95% freedom of transannular patch (TAP) in complete tetralogy repair. METHODS: From August 2006 through May 2010, 139 consecutive patients underwent repair of tetralogy of Fallot at a median age of 6.5 months, with median weight 7.2kg. None of the patients had a prior shunt. A total of 132 patients (95%) had pulmonary valve annulus-sparing procedures, predominantly through a transatrial and transpulmonary approach (n=120%, 86.3%). Special techniques included generous pulmonary supra-valve patch, bicuspid pulmonary leaflets plasty, or augmentation to maximally preserve pulmonary annulus. All the patients who survived were followed up closely. RESULTS: Only seven (5.0%) patients had a TAP. Among them, five (71.4%) had doubly committed subarterial defect. None of the tricuspid pulmonary valves need TAP. Preoperative size of pulmonary annulus<-6 is associated with TAP (p<0.001). A total of 12 (13.7%) patients needed repump to do either a ventriculotomy and patch the incision or a TAP to relieve residual stenosis. One patient needed a third pump run to do a TAP. The operative mortality was 0.7%, and there was one late death due to hemoptysis. The pulmonary regurgitation of non-TAP patients was less than mild in 105 (79.5%) and mild to moderate in 27 (20.5%) patients. Three patients had peak gradient greater than 50mmHg across the right ventricle and pulmonary artery at 1-month follow-up, but the gradient dropped to less than 50mmHg in two patients at 6-month follow-up. One patient had a persistent 50-55mmHg gradient across pulmonary valve and he is under close follow-up. CONCLUSIONS: Excellent outcome can be achieved even with 95% freedom of TAP in complete repair of tetralogy. The function of most patients' pulmonary valve was well preserved.
Authors: Danielle Gottlieb Sen; Marc Najjar; Betul Yimaz; Stéphanie M Levasseur; Bindu Kalessan; Jan M Quaegebeur; Emile A Bacha Journal: Pediatr Cardiol Date: 2016-02-26 Impact factor: 1.655
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