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Current strategies in tetralogy of Fallot repair: pulmonary valve sparing and evolution of right ventricle/left ventricle pressures ratio.
Eur J Cardiothorac Surg. 2009 May; 35(5):885-9; discussion 889-90.EJ

Abstract

OBJECTIVE

Chronic volume overload in repair of tetralogy of Fallot (TOF) with transannular patch leads to significant late morbidity and mortality. Preserving pulmonary valve integrity offers a better long-term prognosis, despite a risk of residual stenosis. In our study we analyzed the evolution of pressure gradients in patients operated with conservative approaches, with particular regard to those babies with an immediate postoperative Prv/Plv ratio >or=0.70.

METHODS

Between January 2000 and June 2008, 24 patients with TOF underwent reparative surgery with a valve sparing procedure (median age 8.1 months, range 1.1-86.6). The intraoperative post-repair echocardiography showed a Prv/Plv ratio >or=0.70 in eight patients (33%, group A) and <0.70 in 16 patients (67%, group B). We realized a retrospective study of pre-, intra-, and postoperative data and of clinical and echocardiographic follow-up data.

RESULTS

There was no early or late mortality, nor functional or rhythmic disturbances. One patient required re-operation for residual stenosis at annular level at one year. After a median follow-up of 32.8 months (range 0.6-73.1), the Prv/Plv ratio decreased by 16% (p=0.001) in all patients. In group A the reduction was 28% (p=0.018) and in group B it was 12% (p=0.14).

CONCLUSIONS

After a valve sparing procedure there is a reduction of Prv/Plv ratio at medium-term follow-up; in our study this reduction was statistically significant in all patients and in the subgroup with higher postoperative ratios. A valve sparing strategy reduces pulmonary regurgitation, preserves RV function and decreases the incidence of late arrhythmias, which are the determinants of long-term outcome.

Authors+Show Affiliations

Pediatric Cardiac Institute of Doce de Otubre University Hospital, Madrid, Spain. lorenzoboni@hotmail.comNo 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

19278860

Citation

Boni, Lorenzo, et al. "Current Strategies in Tetralogy of Fallot Repair: Pulmonary Valve Sparing and Evolution of Right Ventricle/left Ventricle Pressures Ratio." European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, vol. 35, no. 5, 2009, pp. 885-9; discussion 889-90.
Boni L, García E, Galletti L, et al. Current strategies in tetralogy of Fallot repair: pulmonary valve sparing and evolution of right ventricle/left ventricle pressures ratio. Eur J Cardiothorac Surg. 2009;35(5):885-9; discussion 889-90.
Boni, L., García, E., Galletti, L., Pérez, A., Herrera, D., Ramos, V., Marianeschi, S. M., & Comas, J. V. (2009). Current strategies in tetralogy of Fallot repair: pulmonary valve sparing and evolution of right ventricle/left ventricle pressures ratio. European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, 35(5), 885-9; discussion 889-90. https://doi.org/10.1016/j.ejcts.2009.01.016
Boni L, et al. Current Strategies in Tetralogy of Fallot Repair: Pulmonary Valve Sparing and Evolution of Right Ventricle/left Ventricle Pressures Ratio. Eur J Cardiothorac Surg. 2009;35(5):885-9; discussion 889-90. PubMed PMID: 19278860.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Current strategies in tetralogy of Fallot repair: pulmonary valve sparing and evolution of right ventricle/left ventricle pressures ratio. AU - Boni,Lorenzo, AU - García,Enrique, AU - Galletti,Lorenzo, AU - Pérez,Ana, AU - Herrera,Dolores, AU - Ramos,Victoria, AU - Marianeschi,Stefano M, AU - Comas,Juan V, Y1 - 2009/03/10/ PY - 2008/09/01/received PY - 2009/01/04/revised PY - 2009/01/07/accepted PY - 2009/3/13/entrez PY - 2009/3/13/pubmed PY - 2009/11/10/medline SP - 885-9; discussion 889-90 JF - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JO - Eur J Cardiothorac Surg VL - 35 IS - 5 N2 - OBJECTIVE: Chronic volume overload in repair of tetralogy of Fallot (TOF) with transannular patch leads to significant late morbidity and mortality. Preserving pulmonary valve integrity offers a better long-term prognosis, despite a risk of residual stenosis. In our study we analyzed the evolution of pressure gradients in patients operated with conservative approaches, with particular regard to those babies with an immediate postoperative Prv/Plv ratio >or=0.70. METHODS: Between January 2000 and June 2008, 24 patients with TOF underwent reparative surgery with a valve sparing procedure (median age 8.1 months, range 1.1-86.6). The intraoperative post-repair echocardiography showed a Prv/Plv ratio >or=0.70 in eight patients (33%, group A) and <0.70 in 16 patients (67%, group B). We realized a retrospective study of pre-, intra-, and postoperative data and of clinical and echocardiographic follow-up data. RESULTS: There was no early or late mortality, nor functional or rhythmic disturbances. One patient required re-operation for residual stenosis at annular level at one year. After a median follow-up of 32.8 months (range 0.6-73.1), the Prv/Plv ratio decreased by 16% (p=0.001) in all patients. In group A the reduction was 28% (p=0.018) and in group B it was 12% (p=0.14). CONCLUSIONS: After a valve sparing procedure there is a reduction of Prv/Plv ratio at medium-term follow-up; in our study this reduction was statistically significant in all patients and in the subgroup with higher postoperative ratios. A valve sparing strategy reduces pulmonary regurgitation, preserves RV function and decreases the incidence of late arrhythmias, which are the determinants of long-term outcome. SN - 1873-734X UR - https://www.unboundmedicine.com/medline/citation/19278860/Current_strategies_in_tetralogy_of_Fallot_repair:_pulmonary_valve_sparing_and_evolution_of_right_ventricle/left_ventricle_pressures_ratio_ L2 - https://academic.oup.com/ejcts/article-lookup/doi/10.1016/j.ejcts.2009.01.016 DB - PRIME DP - Unbound Medicine ER -