Korean J Pediatr.  2006 Jun;49(6):635-642. 10.3345/kjp.2006.49.6.635.

Early and mid-term results of pulmonary valve reconstruction in surgical repair of tetralogy of Fallot; comparison with other techniques of right ventricular outflow reconstruction

• Wang SW
• Lee YS
• Kim SH
• Kim TH
• Ban JE
• Lee HD
• Chang YH
• Sung SC

• KMID: 2279886
• DOI: http://doi.org/10.3345/kjp.2006.49.6.635

Abstract

PURPOSE: The purpose of this study is to determine whether the new pulmonary valve reconstruction technique prevents short-term postoperative pulmonary regurgitation and improves early and mid-term clinical outcome.
METHODS
We reviewed postoperative echocardiographic variables and chest X-ray films from 31 patients who had undergone valve reconstruction(pulmonary valve reconstruction group:PVR) for the repair of TOF between April 2000 and August 2004. We compared the clinical data of these patients with those from 47 patients who had right ventricular outflow tract reconstruction with a monocusp valve(monocusp ventricular outflow patch group:MVOP) and 22 patients who had a transannular patch repair without a monocusp valve(transannular patch group:TAP).
RESULTS
In the PVR group, 25 patients(81 percent) had trivial or mild pulmonary regurgitation in their early post operative echocardiogram. Only 12 patients(26 percent) in the MVOP group had mild pulmonary regurgitation; and no patient in the TAP group had it. Pulmonary valve function was good in 96 percent of the PVR group, 36 percent of the MVOP group, and none in the TAP group in early post-operative echocardiogram. Follow-up echocardiogram(1, 2, 3, 4 years later) of the MVOP and TAP groups showed moderate pulmonary regurgitation and severely decreased valve function in almost all cases. However, in the PVR group 54 percent(16/28), 50 percent(14/28), 37 percent(9/24), and 31 percent(5/16) of the patients had trivial or mild pulmonary regurgitation 1, 2, 3 and 4 years after operation, respectively. The valve function remained good in 80 percent(24/30), 64 percent(18/28), 57 percent(12/21), and 31 percent(5/16) of the patients 1, 2, 3 and 4 years after operation respectively.
CONCLUSION
Pulmonary valve reconstruction is effective in reducing pulmonary regurgitation and right ventricular dilatation in the repair of TOF, even though regurgitation increases with time. Further study is needed to determine long-term results.

Keyword

Tetralogy of Fallot; Pulmonary regurgitation; Pulmonary valve reconstruction

MeSH Terms

Dilatation
Echocardiography
Follow-Up Studies
Humans
Pulmonary Valve Insufficiency
Pulmonary Valve*
Tetralogy of Fallot*
Thorax
X-Ray Film