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Late homograft valve insertion after transannular patch repair of tetralogy of Fallot.
J Heart Valve Dis. 1998 Jul; 7(4):450-4.JH

Abstract

BACKGROUND AND AIMS OF THE STUDY

Transannular patch repair of tetralogy of Fallot leads to pulmonary insufficiency and progressive right ventricular dilatation responsible for a decreased exercise capacity. We studied the impact of late homograft insertion on the regression of the right ventricular volumes in symptomatic patients.

METHODS

Between July 1992 and August 1996, 15 consecutive patients (age range: 4 to 24 years) were operated on at a median of 13 years (range: 3 to 20 years) after transannular patch repair of tetralogy of Fallot. All patients complained of exertional dyspnea and fatigue. Syncopes were reported in six patients and four patients had sustained episodes of ventricular tachycardia. Fourteen had pulmonary regurgitation grade 3 or 4 and one had an associated stenosis and insufficiency. All patients had a dilated right ventricle. At reoperation, no patients presented with major aneurysm. The patch was resected and the right ventricular outflow tract reconstructed with a cryopreserved pulmonary homograft. Right ventricular volumes were studied before the procedures and at the last follow up consultation.

RESULTS

There was no operative death. One patient who had a concomitant patch repair of a hypoplastic left pulmonary artery needed extracorporeal circulatory support for eight days. After a median follow up of 25 months (range: 3 to 54 months) all patients but one are in NYHA class I. There were no late deaths. The mean end-diastolic diameter of the right ventricle decreased from 36 +/- 9 mm before surgery to 31 +/- 6 mm (not significant). The mean ratio between the end-diastolic diameter of the right and left ventricles decreased from 0.94 +/- 0.3 to 0.74 +/- 0.2 (p < 0.01).

CONCLUSION

An increasing number of patients who had transannular patch repair for tetralogy of Fallot will require reoperation for symptomatic long-term pulmonary regurgitation. Homograft reconstruction of the right ventricular outflow tract of these patients induces regression of their right ventricular dilatation and leads to their functional recovery.

Authors+Show Affiliations

Cliniques Universitaires Saint-Luc, Brussels, Belgium.No 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

9697070

Citation

d'Udekem, Y, et al. "Late Homograft Valve Insertion After Transannular Patch Repair of Tetralogy of Fallot." The Journal of Heart Valve Disease, vol. 7, no. 4, 1998, pp. 450-4.
d'Udekem Y, Rubay J, Shango-Lody P, et al. Late homograft valve insertion after transannular patch repair of tetralogy of Fallot. J Heart Valve Dis. 1998;7(4):450-4.
d'Udekem, Y., Rubay, J., Shango-Lody, P., Ovaert, C., Vliers, A., Caliteaux, M., & Sluysmans, T. (1998). Late homograft valve insertion after transannular patch repair of tetralogy of Fallot. The Journal of Heart Valve Disease, 7(4), 450-4.
d'Udekem Y, et al. Late Homograft Valve Insertion After Transannular Patch Repair of Tetralogy of Fallot. J Heart Valve Dis. 1998;7(4):450-4. PubMed PMID: 9697070.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Late homograft valve insertion after transannular patch repair of tetralogy of Fallot. AU - d'Udekem,Y, AU - Rubay,J, AU - Shango-Lody,P, AU - Ovaert,C, AU - Vliers,A, AU - Caliteaux,M, AU - Sluysmans,T, PY - 1998/8/11/pubmed PY - 1998/8/11/medline PY - 1998/8/11/entrez SP - 450 EP - 4 JF - The Journal of heart valve disease JO - J. Heart Valve Dis. VL - 7 IS - 4 N2 - BACKGROUND AND AIMS OF THE STUDY: Transannular patch repair of tetralogy of Fallot leads to pulmonary insufficiency and progressive right ventricular dilatation responsible for a decreased exercise capacity. We studied the impact of late homograft insertion on the regression of the right ventricular volumes in symptomatic patients. METHODS: Between July 1992 and August 1996, 15 consecutive patients (age range: 4 to 24 years) were operated on at a median of 13 years (range: 3 to 20 years) after transannular patch repair of tetralogy of Fallot. All patients complained of exertional dyspnea and fatigue. Syncopes were reported in six patients and four patients had sustained episodes of ventricular tachycardia. Fourteen had pulmonary regurgitation grade 3 or 4 and one had an associated stenosis and insufficiency. All patients had a dilated right ventricle. At reoperation, no patients presented with major aneurysm. The patch was resected and the right ventricular outflow tract reconstructed with a cryopreserved pulmonary homograft. Right ventricular volumes were studied before the procedures and at the last follow up consultation. RESULTS: There was no operative death. One patient who had a concomitant patch repair of a hypoplastic left pulmonary artery needed extracorporeal circulatory support for eight days. After a median follow up of 25 months (range: 3 to 54 months) all patients but one are in NYHA class I. There were no late deaths. The mean end-diastolic diameter of the right ventricle decreased from 36 +/- 9 mm before surgery to 31 +/- 6 mm (not significant). The mean ratio between the end-diastolic diameter of the right and left ventricles decreased from 0.94 +/- 0.3 to 0.74 +/- 0.2 (p < 0.01). CONCLUSION: An increasing number of patients who had transannular patch repair for tetralogy of Fallot will require reoperation for symptomatic long-term pulmonary regurgitation. Homograft reconstruction of the right ventricular outflow tract of these patients induces regression of their right ventricular dilatation and leads to their functional recovery. SN - 0966-8519 UR - https://www.unboundmedicine.com/medline/citation/9697070/Late_homograft_valve_insertion_after_transannular_patch_repair_of_tetralogy_of_Fallot_ L2 - http://www.diseaseinfosearch.org/result/2720 DB - PRIME DP - Unbound Medicine ER -