Kwang Ho Choi1, Si Chan Sung2, Hyungtae Kim1, Hyung Doo Lee3, Gil Ho Ban3, Geena Kim3, Hee Young Kim4. 1. Research Institute for Convergence of Biomedical Science and Technology, and Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea. 2. Research Institute for Convergence of Biomedical Science and Technology, and Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea. Electronic address: scsung21@hanmail.net. 3. Department of Pediatric Cardiology, Pusan National University Yangsan Hospital, Yangsan, Korea. 4. Department of Anesthesiology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Abstract
BACKGROUND: In tetralogy of Fallot, whether relieving right ventricular outflow tract obstruction requires transannular patch enlargement (TAPE) of the pulmonary valve depends on pulmonary valvular annulus size. The z-score of pulmonary annulus is most commonly used as a predictor of the need for TAPE. However, the z-score is a complex value affected by height, body weight, body surface area, and different reference populations. Therefore, we hypothesized that the great artery annulus size ratio (pulmonary valvular annulus size to aortic valve annuls size [GA ratio]) may be a better predictor of the need for TAPE. METHODS: We analyzed 122 patients retrospectively who had undergone total correction of tetralogy of Fallot between January 2007 and March 2015. We categorized the patients into two groups, TAPE versus non-TAPE. Great arterial annuli sizes were evaluated in each group, and the GA ratio cutoff values for TAPE were calculated. RESULTS: In total, 40 patients (32.8%) required TAPE. Both GA ratios and z-scores were smaller in the TAPE group than in the non-TAPE group (0.51 versus 0.67, p < 0.0001, and -2.46 versus -0.85, p < 0.0001, respectively). In receiver operating characteristics analyses, the z-score and GA ratio cutoff values were -1.67 (area under the curve = 0.797) and 0.56 (area under the curve = 0.900), respectively, demonstrating that the GA ratio was a more powerful diagnostic tool as a predictor of TAPE (p = 0.014). CONCLUSIONS: Our results suggest that the GA ratio is a useful predictor for TAPE and can be applied readily and simply in clinical practice.
BACKGROUND: In tetralogy of Fallot, whether relieving right ventricular outflow tract obstruction requires transannular patch enlargement (TAPE) of the pulmonary valve depends on pulmonary valvular annulus size. The z-score of pulmonary annulus is most commonly used as a predictor of the need for TAPE. However, the z-score is a complex value affected by height, body weight, body surface area, and different reference populations. Therefore, we hypothesized that the great artery annulus size ratio (pulmonary valvular annulus size to aortic valve annuls size [GA ratio]) may be a better predictor of the need for TAPE. METHODS: We analyzed 122 patients retrospectively who had undergone total correction of tetralogy of Fallot between January 2007 and March 2015. We categorized the patients into two groups, TAPE versus non-TAPE. Great arterial annuli sizes were evaluated in each group, and the GA ratio cutoff values for TAPE were calculated. RESULTS: In total, 40 patients (32.8%) required TAPE. Both GA ratios and z-scores were smaller in the TAPE group than in the non-TAPE group (0.51 versus 0.67, p < 0.0001, and -2.46 versus -0.85, p < 0.0001, respectively). In receiver operating characteristics analyses, the z-score and GA ratio cutoff values were -1.67 (area under the curve = 0.797) and 0.56 (area under the curve = 0.900), respectively, demonstrating that the GA ratio was a more powerful diagnostic tool as a predictor of TAPE (p = 0.014). CONCLUSIONS: Our results suggest that the GA ratio is a useful predictor for TAPE and can be applied readily and simply in clinical practice.
Authors: Su Jin Choi; Jung Eun Kwon; Da Eun Roh; Myung Chul Hyun; Hanna Jung; Young Ok Lee; Joon Yong Cho; Yeo Hyang Kim Journal: Clin Exp Pediatr Date: 2019-11-08
Authors: Vishal V Bhende; Tanishq S Sharma; Deepakkumar V Mehta; Krishnan Ganapathy Subramaniam; Amit Kumar; Jigar P Thacker; Viral B Patel; Gurpreet Panesar; Kunal Soni; Kartik B Dhami; Hardil P Majmudar; Nirja Patel; Sohilkhan R Pathan Journal: Clin Case Rep Date: 2022-07-27