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Late pulmonary valve replacement after correction of Fallot's tetralogy.
Thorac Cardiovasc Surg. 2004 Feb; 52(1):23-8.TC

Abstract

BACKGROUND

The aim of this study was to investigate necessity and outcome of late pulmonary valve replacement (PVR) after repair of tetralogy of Fallot (TOF).

METHODS

Hospital records from patients operated on for TOF at our institution between 1960 and 2002 were reviewed and patients were interviewed by questionnaires.

RESULTS

Out of 411 long-term survivors after TOF-repair, 47 (11.4 %) patients required reoperation after 13.2 +/- 7.4 years. Preoperative right ventricular (RV) dilatation was present in 36 (76.6 %) patients including 16 (34 %) with impaired RV function. Isolated PVR was performed in 12 patients (25.5 %). Additional procedures were necessary in 35 patients (74.5 %), including closure of residual defects (VSD, n = 11), tricuspid valve replacement (n = 1) and repair (n = 3). Obstructive right ventricular or pulmonary artery lesions (34 patients, 72.3 %) were all surgically addressed. RV pressure decreased from 61.1 +/- 27.7 to 42.9 +/- 13.3 mm Hg (p < 0.01) after PVR. RV size was reduced and RV function improved compared to preoperative values. Early mortality after reoperation was 2.1 % (n = 1) with one patient dying from biventricular failure. There was no late mortality.

CONCLUSIONS

PVR after Fallot repair is frequently required because of progressive RV enlargement with dysfunction. It can be performed with relatively low risk, even in the setting of multiple reoperation. Obstructive lesions (RVOTO, PA stenosis) and residual defects are frequently observed in patients needing late PVR and may play a crucial role in the development of RV failure. Timely valve replacement with repair of all obstructive lesions proximal and distal to the implanted valve is the key to preserving RV function.

Authors+Show Affiliations

Zentrum für Herzchirurgie, Universitätsklinik Erlangen-Nürnberg, Germany. Robert.Cesnjevar@herz.imed.uni-erlangen.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

15002072

Citation

Cesnjevar, R, et al. "Late Pulmonary Valve Replacement After Correction of Fallot's Tetralogy." The Thoracic and Cardiovascular Surgeon, vol. 52, no. 1, 2004, pp. 23-8.
Cesnjevar R, Harig F, Raber A, et al. Late pulmonary valve replacement after correction of Fallot's tetralogy. Thorac Cardiovasc Surg. 2004;52(1):23-8.
Cesnjevar, R., Harig, F., Raber, A., Strecker, T., Fischlein, T., Koch, A., Weyand, M., & Pfeiffer, S. (2004). Late pulmonary valve replacement after correction of Fallot's tetralogy. The Thoracic and Cardiovascular Surgeon, 52(1), 23-8.
Cesnjevar R, et al. Late Pulmonary Valve Replacement After Correction of Fallot's Tetralogy. Thorac Cardiovasc Surg. 2004;52(1):23-8. PubMed PMID: 15002072.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Late pulmonary valve replacement after correction of Fallot's tetralogy. AU - Cesnjevar,R, AU - Harig,F, AU - Raber,A, AU - Strecker,T, AU - Fischlein,T, AU - Koch,A, AU - Weyand,M, AU - Pfeiffer,S, PY - 2004/3/6/pubmed PY - 2004/11/9/medline PY - 2004/3/6/entrez SP - 23 EP - 8 JF - The Thoracic and cardiovascular surgeon JO - Thorac Cardiovasc Surg VL - 52 IS - 1 N2 - BACKGROUND: The aim of this study was to investigate necessity and outcome of late pulmonary valve replacement (PVR) after repair of tetralogy of Fallot (TOF). METHODS: Hospital records from patients operated on for TOF at our institution between 1960 and 2002 were reviewed and patients were interviewed by questionnaires. RESULTS: Out of 411 long-term survivors after TOF-repair, 47 (11.4 %) patients required reoperation after 13.2 +/- 7.4 years. Preoperative right ventricular (RV) dilatation was present in 36 (76.6 %) patients including 16 (34 %) with impaired RV function. Isolated PVR was performed in 12 patients (25.5 %). Additional procedures were necessary in 35 patients (74.5 %), including closure of residual defects (VSD, n = 11), tricuspid valve replacement (n = 1) and repair (n = 3). Obstructive right ventricular or pulmonary artery lesions (34 patients, 72.3 %) were all surgically addressed. RV pressure decreased from 61.1 +/- 27.7 to 42.9 +/- 13.3 mm Hg (p < 0.01) after PVR. RV size was reduced and RV function improved compared to preoperative values. Early mortality after reoperation was 2.1 % (n = 1) with one patient dying from biventricular failure. There was no late mortality. CONCLUSIONS: PVR after Fallot repair is frequently required because of progressive RV enlargement with dysfunction. It can be performed with relatively low risk, even in the setting of multiple reoperation. Obstructive lesions (RVOTO, PA stenosis) and residual defects are frequently observed in patients needing late PVR and may play a crucial role in the development of RV failure. Timely valve replacement with repair of all obstructive lesions proximal and distal to the implanted valve is the key to preserving RV function. SN - 0171-6425 UR - https://www.unboundmedicine.com/medline/citation/15002072/Late_pulmonary_valve_replacement_after_correction_of_Fallot's_tetralogy_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2004-817798 DB - PRIME DP - Unbound Medicine ER -