Pulmonary valve replacement pvr is a safe procedure that will eliminate pr, but timing and indications are evolving. To correct pulmonary regurgitation, the use of bioprosthesis is the first choice at our center. In children with lesions involving pulmonary stenosis, the pulmonary valve is often excised and the right ventricular outflow tract is augmented with a transannular outflow tract patch. Pulmonary valve replacement in tetralogy of fallot. Patients with symptomatic exercise intolerance are likely to have improvement in symptoms and quality of life and should be offered pvr. Techniques aimed at restoring pulmonary valve competence utilizing the remaining valve leaflets after transannular patch placement have recently been proposed for very select patient populations. Transcatheter pulmonary valve replacement tpvr is an accepted therapy for treatment of dysfunctional right ventricular outflow tract rvot conduits.
A 31yearold man with history of tetralogy of fallot, status postsurgical repair with a transannular patch repair, and patch closure of the ventricular septal defect as a neonate, presented with symptomatic severe pulmonic regurgitation pr. In the tetralogy of fallot group, 24 out of 57 patients underwent primary repair with. Most of these patients have a history of surgical repair with a transannular patch ie, pulmonary valve not preserved. Pulmonary valve replacement in adult congenital cardiac. Pulmonary valve leaflets that are preserved at initial surgery may grow and develop normal morphology and subsequent valve repair may be possible.
Background pulmonary valve replacement pvr in repaired tetralogy of fallot tof reduces pulmonary regurgitation and decreases right ventricular rv dilation, but its longterm impact on ventricular tachycardia vt and mortality is unknown. To this end we have used a strategy of transatrial, transpulmonary repair of tof with aggressive pulmonary valve commissurotomy, extensive subvalvar resection, pantaloon pericardial supravalvar pulmonary arterial patching, and, when required, subvalvar. Apr 18, 20 the optimal zscore for transannular patch article pdf available in european journal of cardiothoracic surgery. Pulmonary valve replacement in tetralogy of fallot circulation. Percutaneous valve interventions are now a cornerstone of not just the congenital cardiologist treating patients with congenital heart disease, but alsoand numerically more importantlyfor adult interventional cardiologists treating patients with acquired heart valve disease. Development of a novel hybrid strategy for transcatheter.
The narrowing in the pulmonary valve is also repaired with the transannular patch to improve blood flow to the lungs. Valvesparing surgery for tetralogy of fallot procedure. Late repair of the native pulmonary valve in patients with. Mosca, md surgical palliation of tetralogy of fallot often involves pulmonary valvotomy, a transannular patch, or incision in the right ventricular rv infundibulum, all of which can contribute to longterm pulmonary valve pv regurgita. If the valve is dysplastic, pulmonary valve replacement is more likely to be required, and if annular or pulmonary trunk hypoplasia is present, a transannular patch may be necessary.
All the atrial septal defects were closed, as can be seen in figure 2, figure 3. Pulmonary valve replacement in adults late after repair of. Use of a pulmonary neovalve with a transannular patch for repair. Pulmonary valve replacement after repair of tetralogy of fallot. Bioprosthetic pulmonary valve replacement okayama university. In these situations, the anterior leaflet can be resected in association with a transannular patch with a reasonable possibility that the remaining valve leaflets, if not sacrificed, would be available for a valve restoration procedure by bicuspidization. Early versus late pulmonary valve replacement in patients with.
We use the strategy of the limited transannular patch. Early versus late pulmonary valve replacement in patients. Even with this goal in mind, the situation frequently arises that a transannular patch repair is required to augment the right ventricular outflow tract 15, 16. Right ventricular outflow tract obstruction was relieved by a transannular patch in 14 cases 42%, with a ptfe monocusp in 4 cases, by an infundibular patch with preservation of the pulmonary valve in 7 cases 21%, and a right ventricletopulmonary artery valved conduit interposition was used in 11 cases 33%. Since then, several operative techniques have been re ported, including transatrial repair of the vsd and.
Pulmonary valve restitution following transannular patch. Pulmonary valve replacement pvr is a safe procedure that will. Bioprosthetic pulmonary valve replacement operative. Although tolerated in early life, by the second decade of life pr is associated with an increased risk of death because of ventricular arrhythmias. At present, the majority of fallot patients who undergo transannular patch tap repair are not candidates for tpvr due to the large irregular nature of their rvot. Native pulmonary valve restoration after remote tetralogy of.
Development of a novel hybrid strategy for transcatheter pulmonary valve placement in patients following transannular patch repair of tetralogy of fallot. Occasionally, surgical repair of pulmonary stenosis may be required. Chronic pulmonary insufficiency following transannular patch repair of tetralogy of fallot may mandate restoration of a competent pulmonary valve. Tetralogy of fallot with pulmonary stenosis treatment. The cohort included 9 patients with a median age of 18. Tetralogy of fallot with absent pulmonary valve syndrome is a form of tetralogy of fallot with a severely dysplastic pulmonary valve and markedly dilated pulmonary arteries. For the group as a whole, the degree of pulmonary regurgitation was positively associated with pulmonary annulus diameter estimated at cmr p oct 18, 2016 the bovine pericardial patch is sutured to the pulmonary artery, and the suture line is carried at the level of the valve on both sides. Pulmonary effects on exercise testing in tetralogy of. Cardiovascular mr imaging after surgical correction of.
Early versus late pulmonary valve replacement in patients with transannular patch repaired tetralogy of fallot. Jul 11, 2012 pulmonary valve replacement is a relatively uncommon operation in adults, with the exception of those patients operated on previously for congenital heart disease. Pulmonary valve replacement was performed through a median sternotomy using standard cardiopulmonary bypass and mild systemic hypothermia 32 and 35c in all patients. Timing and technique of pulmonary valve replacement in the. Bioprosthetic pulmonary valves were sewn into the pulmonary annulus and covered with a patch of autologous pericardium. Pulmonary valve preservation strategies for tetralogy of. Transcatheter pulmonary valve replacement tpvr is one of the. Right ventricular dysfunction and pulmonary valve replacement after correction of tetralogy of fallot. In the tetralogy of fallot group, 24 out of 57 patients underwent primary repair with a transannular patch. The bovine pericardial patch is sutured to the pulmonary artery, and the suture line is carried at the level of the valve on both sides. Pulmonary valve replacement in adults late after repair of tetralogy of fallot. Treatment of fallot tetralogy with a transannular patch. Ten to twenty years after the initial repair, severe pulmonary regurgitation results in right ventricular dilation and dysfunction. Pulmonary valve repair and replacement mayo clinic.
This study aimed to determine the incidence of death and vt in tof after pvr and to test the. Recent evidence indicates, however, that use of a transannular patch can cause pulmonary insufficiency, or weakness in the pulmonary valve that allows backflow of blood into the right ventricle. At our institution we have made a conscious effort to avoid the use of transannular patching to preserve a functional pulmonary valve. A novel predictive value for the transannular patch enlargement in. Establishing unobstructed blood flow between the right ventricle rv and the confluence of the pulmonary arteries using the transannular patch technique or via the insertion of an interposition graft valve between the rv and pulmonary artery have been the main surgical options for such defects.
Pulmonary valve replacement is a relatively uncommon operation in adults, with the exception of those patients operated on previously for congenital heart disease. Pulmonary valve replacement after repair of tetralogy of. Phillips abm, nevin p, shah a, shah a, olshove v, garg r, et al. This patch covers part of the wall of the right ventricle as well as widening the pulmonary artery and pulmonary valve. Pulmonary regurgitation can occur after transannular patch or valvesparing repairs. Pulmonary valve restitution following transannular patch repair of. Bioprosthetic pulmonary valve replacement sciencedirect. Transannular patching is a valid alternative for tetralogy of. However, if there is also a need to widen the outflow tract of the right ventricle, a transannular patch may be required. Pulmonary stenosis congenital heart disease cove point. Pulmonary valve restitution following transannular patch repair of tetralogy of fallot. This can lead to significant pulmonary insufficiency and increased right ventricular volumes and ultimately pulmonary valve replacement. For most pulmonary valve repair and replacement procedures, youll receive medications anesthetics that put you in a sleeplike state so you wont feel any pain during the surgery. Patients with arrhythmias or prolonged qrs duration are candidates for pvr.
The surgical treatment of malformations of the heart in which there is pulmonary stenosis or pulmonary atresia. The conditions for valve repair rather than valve replacement were unique. Mar 30, 2017 tetralogy of fallot with absent pulmonary valve syndrome. Valve orientation laminar flow not too large prosthesis. If a patch is inserted, it may be used to widen the pulmonary artery from the valve upward. If the obstruction is due to thickened muscle tissue below the pulmonary valve. This study aimed to determine the incidence of death and vt in tof after pvr and to test the hypothesis that pvr leads to. The optimal zscore for transannular patch article pdf available in european journal of cardiothoracic surgery. Native right ventricular outflow tract transcatheter. It is recognized that pv insufficiency has serious deleterious effects. Indications for pulmonary valve replacement in repaired tetralogy of fallot. The patch is folded and the ring of the valve is fixed to the transannular patch at the level of the fold. Tetralogy of fallot patients repaired with a transannular patch without pulmonary valve replacement were compared with age, gender, and sizematched normal controls.
Although surgical replacement of the pv is efficacious, artificial valves inevitably fail and require reintervention. Ct and mr imaging of the pulmonary valve radiographics. Jun 29, 20 in this article, we demonstrate the expected cardiovascular mr imaging appearance of the heart following each of the three most common surgical methods for correction of the right ventricular outflow tract rvot lesions in tof. Pulmonary regurgitation can occur after transannular patch or valve sparing repairs. For the group as a whole, the degree of pulmonary regurgitation was positively associated with pulmonary annulus diameter estimated at cmr p pulmonary regurgitation pr is also commonly present. Early versus late pulmonary valve replacement in patients with transannular patchrepaired tetralogy of fallot. Hcpcs codes not covered for indications listed in the cpb. Physiological and phenotypic characteristics of late. Valvesparing surgery for tetralogy of fallot procedure details. This relatively rare lesion represents only 35% of all cases of tetralogy of fallot. In patients with pulmonary stenosis and substantial pulmonary regurgitation, valve replacement is required. Pulmonary effects on exercise testing in tetralogy of fallot. An increasing number of patients will require pulmonary valve replacement following repair of tetralogy of fallot. Youll also be connected to a heartlung bypass machine, which keeps blood moving through your body during the procedure.
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