Fate of the pericardial monocusp pulmonary valve for right ventricular outflow tract reconstruction. Early function, late failure without obstruction.

Sudden change from a pressure-loaded to a volume-loaded right ventricle as a result of transannular patch reconstruction of the right ventricular outflow tract may result in early hemodynamic compromise. Tri-leaflet porcine valves in conduits function well early but typically create late obstruction. We studied the fate of a pericardial monocusp valve constructed during transannular patch reconstruction for right ventricular outflow tract obstruction in 19 patients, 2 weeks to 27 years of age (mean age 61 months). Patients had the monocusp constructed of autologous (n = 16) or bovine pericardium (n = 3) when the former was not available during transannular patch reconstruction associated with repair of tetralogy of Fallot (n = 12), pulmonary stenosis/atresia (n = 4), and truncus arteriosus (n = 3). Function of the monocusp was assessed by presence of a split-second heart sound, echocardiographic assessment of right ventricular dilatation, monocusp competence, and fluoroscopic evaluation of monocusp motion. Functional assessments were accomplished immediately after the operation and at 2, 6, 12, and 24 months after the operation. There were no operative deaths, but there was one late hospital death. Sixteen of nineteen patients (84%) had competent pulmonary monocusp valves immediately after the operation, but, by 24 months, only one of seven patients (14%) had a competent valve. No patient had monocusp stenosis. We conclude that a pericardial monocusp valve for right ventricular outflow tract reconstruction provides excellent early hemodynamic function but that these effects are limited in duration. Because late stenosis has not been seen, this inexpensive and easily constructed valve can be used as an excellent short-term adjunct to right ventricular outflow tract reconstruction.