scholarly journals HEMODYNAMIC EFFECTS OF PULMONARY VALVE REPLACEMENT FOR PULMONARY REGURGITATION AFTER REPAIR OF ISOLATED PULMONARY STENOSIS: A MATCHED COMPARISON WITH TETRALOGY OF FALLOT

2015 ◽  
Vol 65 (10) ◽  
pp. A536
Author(s):  
Jouke Pieter Bokma ◽  
Michiel Winter ◽  
Thomas Oosterhof ◽  
Hubert Vliegen ◽  
Arie Van Dijk ◽  
...  
Author(s):  
Simone Ghiselli ◽  
Cristina Carro ◽  
Nicola Uricchio ◽  
Giuseppe Annoni ◽  
Stefano M Marianeschi

Abstract OBJECTIVES Chronic pulmonary valve (PV) regurgitation is a common late sequela after repair of congenital heart diseases like tetralogy of Fallot or pulmonary stenosis, leading to right ventricular dilatation and failure and increased late morbidity and mortality. Timely reoperation may lead to a complete right ventricular recovery. An injectable PV allows pulmonary valve replacement, with or without cardiopulmonary bypass, under direct observation, thereby minimizing the impact of surgery on cardiac function. The aim of this study was to evaluate the feasibility and mid- to long-term clinical outcomes with this device. METHODS From April 2007 to October 2019, a total of 85 symptomatic patients with severe pulmonary regurgitation or pulmonary stenosis underwent pulmonary valve replacement with an injectable stented pulmonary prosthesis. Data were collected from the international proctoring registry. Mean patient age was 26.7 years. The underlying diagnosis was repaired tetralogy of Fallot in 69.4% patients; moderate or severe pulmonary regurgitation was present in 72.9%. All patients had echocardiographic scans before the operation and during the follow-up period. A total of 54.1% patients also had preoperative/postoperative cardiac magnetic resonance imaging (MRI) or catheterization; 25.9% had off-pump implants. In 53% patients, pulmonary valve replacement was associated with the repair of other cardiac defects. RESULTS Minor postoperative complications were observed in 10.8% patients. The overall mortality rate was 2.3%; mortality after valve replacement was linked to a severe cardiac insufficiency and it was not related to a prosthesis failure; 1 prosthesis was explanted from 1 patient because of endocarditis, and 6% of patients developed PV stenosis; minor complications occurred in 4.8%. The mean follow-up period was 4.8 years (2 months–12.7 years); 42% of the patients were followed for more than 5 years. Follow-up echocardiography and cardiac MRI showed a significant reduction in RV size and low gradients across the PV. CONCLUSIONS An injectable PV may be implanted without cardiopulmonary bypass and in a hybrid operating theatre with minimal surgical impact. The bioprosthesis, available up to large sizes, has a low profile, laminar flow and no risk of coronary artery compression. Incidence of endocarditis is rare. The lack of a suture ring permits the implant of a relatively larger prosthesis, thereby avoiding a right ventricular outflow tract obstruction. This device permits future percutaneous valve-in-valve procedures, if needed. Results concerning durability are encouraging, and mid- to long-term haemodynamic performance is excellent.


2014 ◽  
Vol 9 (1) ◽  
pp. 54-55
Author(s):  
Rezwanul Haque Bulbul ◽  
Omar Sadeque Khan ◽  
Mohammad Samir Azam Sunny ◽  
Swadesh Ranjan Sarker ◽  
Mostafa Nuruzzaman

Pulmonary valve replacement for pulmonary regurgitation is a common practise. Pulmonary stenosis relief or after release of right ventricular outflow tract obstruction, progressive pulmonary regurgitation leading to biventricular failure is a big problem. If early pulmonary valve replacement done by homograft or tissue valve then we can overcome this problem. In our case report we have done pulmonary valve replacement by Edward life science Tissue valve for calcified pulmonary valve. And our patient showed a good response after valve replacement. DOI: http://dx.doi.org/10.3329/uhj.v9i1.19514 University Heart Journal Vol. 9, No. 1, January 2013; 54-55


2012 ◽  
Vol 94 (6) ◽  
pp. 2077-2082 ◽  
Author(s):  
Annelies E. van der Hulst ◽  
Marije G. Hylkema ◽  
Hubert W. Vliegen ◽  
Victoria Delgado ◽  
Mark G. Hazekamp ◽  
...  

2016 ◽  
Vol 67 (9) ◽  
pp. 1123-1124 ◽  
Author(s):  
Jouke P. Bokma ◽  
Michiel M. Winter ◽  
Thomas Oosterhof ◽  
Hubert W. Vliegen ◽  
Arie P. van Dijk ◽  
...  

2015 ◽  
Vol 26 (5) ◽  
pp. 860-866 ◽  
Author(s):  
Eva A. Nielsen ◽  
Vibeke E. Hjortdal

AbstractBackgroundSurgical correction was the treatment of choice for pulmonary stenosis until three decades ago, when balloon valvuloplasty was implemented. The natural history of surgically relieved pulmonary stenosis has been considered benign but is actually unknown, as is the need for re-intervention.The objective of this study was to investigate the morbidity and mortality of patients with surgically treated pulmonary stenosis operated at Aarhus University Hospital between 1957 and 2000.ResultsThe total study population included 80 patients. In-hospital mortality was 2/80 (2.5%), and an additional four patients died after hospital discharge; therefore, the long-term mortality was 5%. The maximum follow-up period was 57 years, with a median of 33 years. In all, 16 patients (20%) required at least one re-intervention. Pulmonary valve replacement due to pulmonary regurgitation was the most common re-intervention (67%). Freedom from re-intervention decreased >20 years after the initial repair. In addition, 45% of patients had moderate/severe pulmonary regurgitation, 38% had some degree of right ventricular dilatation, and 40% had some degree of tricuspid regurgitation, which did not require re-intervention at the present stage.ConclusionSurgical relief for pulmonary stenosis is efficient in relieving outflow obstruction; however, this efficiency is achieved at the cost of pulmonary regurgitation, leading to right ventricular dilatation and tricuspid regurgitation. When required, pulmonary valve replacement is performed most frequently >20 years after the initial surgery. Lifelong follow-up of patients treated surgically for pulmonary stenosis is emphasised in this group of patients, who might otherwise consider themselves cured.


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