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The right and left ventricular function after surgical correction with pericardial monocusp in tetralogy of fallot: mid-term result.
J Med Assoc Thai. 2002 Nov; 85 Suppl 4:S1266-74.JM

Abstract

BACKGROUND

Surgical repair of tetralogy of Fallot (TOF) with reconstruction of the right ventricular (RV) outflow tract invariably results in pulmonary regurgitation (PR). Chronic PR has been associated with RV dysfunction and ventricular arrhythmia. Pericardial monocusp has recently been used at Ramathibodi Hospital to preserve pulmonary valve function.

OBJECTIVES

First, to study the competency of the pericardial monocusp, one-year after correction. Second, to assess the right and left ventricular (LV) functions after surgery. Third, to assess correlation between severity of PR and the characters of electrocardiography (ECG) and chest X-ray (CXR) after correction.

METHOD

A cross-sectional study was conducted in patients who, had undergone total correction for TOF at least one year ago. The past medical history was retrospectively reviewed from the medical records. The patients who underwent surgical correction with and without pericardial monocusp were recruited into group I and group II, respectively. The clinical symptoms, QRS duration from ECG, and cardio-thoracic (CT) ratio from CXR were analyzed. From the echocardiographic standpoint, the LV systolic function was determined by LV fractional shortening (LVFS), whereas the RV systolic function was determined by the tricuspid annular plane systolic excursion (TAPSE). Restrictive physiology of the RV was determined by presence of antegrade flow across the pulmonary valve during diastole.

RESULTS

Sixty four patients were enrolled in the study, 7 in group I and 57 in group II. The median follow-up time after the surgery was 6.5 years, which was 3 years in group I and 7 years in group II (p < 0.01). All patients in group I (100%) and 45 (80.4%) in group II had moderate or severe PR. The severity of PR, the RV and LV systolic functions were not statistically significantly different between the two groups (p > 0.01). The median of the LVFS was 32.4 per cent, and of the TAPSE was 10.5 mm. There was no restrictive physiology of the RV in all patients. There were no significant correlations between symptoms, CT-ratio, QRS duration and the severity of PR.

CONCLUSIONS

The pericardial monocusp could neither reduce severity of PR nor improve right and left ventricular functions after 3 years follow-up post-operatively. However, the right and left ventricular performances in mid-term period remained insignificantly changed and severity of PR could not be predicted from symptoms and simple laboratory investigations.

Authors+Show Affiliations

Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12549805

Citation

Promphan, Worakan, et al. "The Right and Left Ventricular Function After Surgical Correction With Pericardial Monocusp in Tetralogy of Fallot: Mid-term Result." Journal of the Medical Association of Thailand = Chotmaihet Thangphaet, vol. 85 Suppl 4, 2002, pp. S1266-74.
Promphan W, Attanawanit S, Wanitkun S, et al. The right and left ventricular function after surgical correction with pericardial monocusp in tetralogy of fallot: mid-term result. J Med Assoc Thai. 2002;85 Suppl 4:S1266-74.
Promphan, W., Attanawanit, S., Wanitkun, S., & Khowsathit, P. (2002). The right and left ventricular function after surgical correction with pericardial monocusp in tetralogy of fallot: mid-term result. Journal of the Medical Association of Thailand = Chotmaihet Thangphaet, 85 Suppl 4, S1266-74.
Promphan W, et al. The Right and Left Ventricular Function After Surgical Correction With Pericardial Monocusp in Tetralogy of Fallot: Mid-term Result. J Med Assoc Thai. 2002;85 Suppl 4:S1266-74. PubMed PMID: 12549805.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The right and left ventricular function after surgical correction with pericardial monocusp in tetralogy of fallot: mid-term result. AU - Promphan,Worakan, AU - Attanawanit,Sukasom, AU - Wanitkun,Suthep, AU - Khowsathit,Pongsak, PY - 2003/1/29/pubmed PY - 2003/2/14/medline PY - 2003/1/29/entrez SP - S1266 EP - 74 JF - Journal of the Medical Association of Thailand = Chotmaihet thangphaet JO - J Med Assoc Thai VL - 85 Suppl 4 N2 - BACKGROUND: Surgical repair of tetralogy of Fallot (TOF) with reconstruction of the right ventricular (RV) outflow tract invariably results in pulmonary regurgitation (PR). Chronic PR has been associated with RV dysfunction and ventricular arrhythmia. Pericardial monocusp has recently been used at Ramathibodi Hospital to preserve pulmonary valve function. OBJECTIVES: First, to study the competency of the pericardial monocusp, one-year after correction. Second, to assess the right and left ventricular (LV) functions after surgery. Third, to assess correlation between severity of PR and the characters of electrocardiography (ECG) and chest X-ray (CXR) after correction. METHOD: A cross-sectional study was conducted in patients who, had undergone total correction for TOF at least one year ago. The past medical history was retrospectively reviewed from the medical records. The patients who underwent surgical correction with and without pericardial monocusp were recruited into group I and group II, respectively. The clinical symptoms, QRS duration from ECG, and cardio-thoracic (CT) ratio from CXR were analyzed. From the echocardiographic standpoint, the LV systolic function was determined by LV fractional shortening (LVFS), whereas the RV systolic function was determined by the tricuspid annular plane systolic excursion (TAPSE). Restrictive physiology of the RV was determined by presence of antegrade flow across the pulmonary valve during diastole. RESULTS: Sixty four patients were enrolled in the study, 7 in group I and 57 in group II. The median follow-up time after the surgery was 6.5 years, which was 3 years in group I and 7 years in group II (p < 0.01). All patients in group I (100%) and 45 (80.4%) in group II had moderate or severe PR. The severity of PR, the RV and LV systolic functions were not statistically significantly different between the two groups (p > 0.01). The median of the LVFS was 32.4 per cent, and of the TAPSE was 10.5 mm. There was no restrictive physiology of the RV in all patients. There were no significant correlations between symptoms, CT-ratio, QRS duration and the severity of PR. CONCLUSIONS: The pericardial monocusp could neither reduce severity of PR nor improve right and left ventricular functions after 3 years follow-up post-operatively. However, the right and left ventricular performances in mid-term period remained insignificantly changed and severity of PR could not be predicted from symptoms and simple laboratory investigations. SN - 0125-2208 UR - https://www.unboundmedicine.com/medline/citation/12549805/The_right_and_left_ventricular_function_after_surgical_correction_with_pericardial_monocusp_in_tetralogy_of_fallot:_mid_term_result_ L2 - http://www.diseaseinfosearch.org/result/2720 DB - PRIME DP - Unbound Medicine ER -