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Right ventricular outflow tract reconstruction for pulmonary regurgitation after repair of tetralogy of Fallot. Preliminary results.
Eur J Cardiothorac Surg. 2007 Apr; 31(4):654-8.EJ

Abstract

BACKGROUND

Pulmonary regurgitation after tetralogy of Fallot (ToF) repair is associated with right ventricular dilatation, failure and arrhythmia. Timing and technique for re-intervention remain controversial.

METHODS

Our recent approach is to reconstruct the dilated right ventricle outflow tract (RVOT) as a fibro-muscular sleeve to support a pulmonary homograft valve conduit in orthotopic position. Indication is based on clinical and magnetic resonance (MR) criteria. We reviewed all patients who underwent RVOT reconstruction between January 2004 and February 2005. There were seven children (mean age 14+/-2 years) operated 13+/-2 years after ToF repair, and 12 adults (mean age 30+/-15 years) operated 23+/-10 years after ToF repair. Exercise testing and MR evaluation prior to surgery and at 1 year postoperative follow-up were compared.

RESULTS

There was no operative mortality. At 1 year, pulmonary regurgitation was mild or less in 16/19 patients. Right ventricular (RV) end-diastolic (158+/-51 to 103+/-36ml/m(2), p<0.001) and end-systolic volumes (85+/-42 to 49+/-24ml/m(2), p=0.001) fell significantly. Importantly, effective RV stroke volume (43+/-10 to 48+/-7ml/m(2), p=0.019) and left ventricular (LV) stroke volume (43+/-7 to 47+/-7ml/m(2), p=0.009) increased significantly. The mean RV/LV end-diastolic volume ratio fell markedly in both children and adults (2.22+/-0.62 to 1.38+/-0.52). However, no improvement in maximal VO(2) on exercise was noted in either group.

CONCLUSIONS

RVOT reconstruction restored valve function, improved RV dimensions and left and right stroke volumes. Maximal exercise capacity did not improve in either children or adults.

Authors+Show Affiliations

Great Ormond Street Hospital for Children, The Heart Hospital, Institute of Child Health, London, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17267236

Citation

Ghez, Olivier, et al. "Right Ventricular Outflow Tract Reconstruction for Pulmonary Regurgitation After Repair of Tetralogy of Fallot. Preliminary Results." European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, vol. 31, no. 4, 2007, pp. 654-8.
Ghez O, Tsang VT, Frigiola A, et al. Right ventricular outflow tract reconstruction for pulmonary regurgitation after repair of tetralogy of Fallot. Preliminary results. Eur J Cardiothorac Surg. 2007;31(4):654-8.
Ghez, O., Tsang, V. T., Frigiola, A., Coats, L., Taylor, A., Van Doorn, C., Bonhoeffer, P., & De Leval, M. (2007). Right ventricular outflow tract reconstruction for pulmonary regurgitation after repair of tetralogy of Fallot. Preliminary results. European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, 31(4), 654-8.
Ghez O, et al. Right Ventricular Outflow Tract Reconstruction for Pulmonary Regurgitation After Repair of Tetralogy of Fallot. Preliminary Results. Eur J Cardiothorac Surg. 2007;31(4):654-8. PubMed PMID: 17267236.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Right ventricular outflow tract reconstruction for pulmonary regurgitation after repair of tetralogy of Fallot. Preliminary results. AU - Ghez,Olivier, AU - Tsang,Victor T, AU - Frigiola,Alessandra, AU - Coats,Louise, AU - Taylor,Andrew, AU - Van Doorn,Carin, AU - Bonhoeffer,Philip, AU - De Leval,Marc, Y1 - 2007/01/30/ PY - 2006/09/12/received PY - 2006/11/25/revised PY - 2006/12/22/accepted PY - 2007/2/3/pubmed PY - 2007/6/29/medline PY - 2007/2/3/entrez SP - 654 EP - 8 JF - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JO - Eur J Cardiothorac Surg VL - 31 IS - 4 N2 - BACKGROUND: Pulmonary regurgitation after tetralogy of Fallot (ToF) repair is associated with right ventricular dilatation, failure and arrhythmia. Timing and technique for re-intervention remain controversial. METHODS: Our recent approach is to reconstruct the dilated right ventricle outflow tract (RVOT) as a fibro-muscular sleeve to support a pulmonary homograft valve conduit in orthotopic position. Indication is based on clinical and magnetic resonance (MR) criteria. We reviewed all patients who underwent RVOT reconstruction between January 2004 and February 2005. There were seven children (mean age 14+/-2 years) operated 13+/-2 years after ToF repair, and 12 adults (mean age 30+/-15 years) operated 23+/-10 years after ToF repair. Exercise testing and MR evaluation prior to surgery and at 1 year postoperative follow-up were compared. RESULTS: There was no operative mortality. At 1 year, pulmonary regurgitation was mild or less in 16/19 patients. Right ventricular (RV) end-diastolic (158+/-51 to 103+/-36ml/m(2), p<0.001) and end-systolic volumes (85+/-42 to 49+/-24ml/m(2), p=0.001) fell significantly. Importantly, effective RV stroke volume (43+/-10 to 48+/-7ml/m(2), p=0.019) and left ventricular (LV) stroke volume (43+/-7 to 47+/-7ml/m(2), p=0.009) increased significantly. The mean RV/LV end-diastolic volume ratio fell markedly in both children and adults (2.22+/-0.62 to 1.38+/-0.52). However, no improvement in maximal VO(2) on exercise was noted in either group. CONCLUSIONS: RVOT reconstruction restored valve function, improved RV dimensions and left and right stroke volumes. Maximal exercise capacity did not improve in either children or adults. SN - 1010-7940 UR - https://www.unboundmedicine.com/medline/citation/17267236/Right_ventricular_outflow_tract_reconstruction_for_pulmonary_regurgitation_after_repair_of_tetralogy_of_Fallot__Preliminary_results_ L2 - https://academic.oup.com/ejcts/article-lookup/doi/10.1016/j.ejcts.2006.12.031 DB - PRIME DP - Unbound Medicine ER -