Value of pulmonary annulus index in predicting transannular patch in tetralogy of Fallot repair

Background: Although valve-sparing repair remains ideal for patients with tetralogy of Fallot, the durability of valve-sparing repair and which patients may have been better served with a transannular patch remain unclear. Methods: Retrospective review was performed of tetralogy of Fallot operations at our institution from January 2008 to December 2018. Standard demographic data were collected, including echocardiographic parameters, operative details, and clinical outcomes. Statistical analysis was performed comparing the transannular patch and valve-sparing repair groups. Results: Sixty-seven patients underwent tetralogy of Fallot repair with a median age of 4.5 (3.2-6.0) months and weight of 5.8 (5.2, 6.7) kg. Seventeen (25%) patients underwent transannular patch repair and 50 (75%) patients underwent valve-sparing repair. There was no difference in age or weight between patients who underwent a transannular patch repair and those who underwent a valve-sparing repair. At last follow-up (median 42 months), there was a trend of a higher peak pulmonary valve/right ventricular outflow tract gradient ( P = .06) in the valve-sparing group, but no difference in the pulmonary valve annulus z-scores. Additionally, the pulmonary valve z-scores in the valve-sparing group decreased from −2.3 ± 1.0 on predischarge echocardiogram of to −1.2 ± 1.6 on last follow-up, with the peak gradient on predischarge 23 (0-37) mm Hg remaining stable on last follow-up at 18 (0-29) mm Hg. There was one reoperation: pulmonary valve replacement six years after a transannular patch. Conclusions: Obtaining a postrepair pulmonary valve z-score of −2 yields satisfactory, stable valve-sparing repair with pulmonary valve growth, acceptable gradients, minimal regurgitation, and high freedom from reintervention during follow-up.

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Alterations in regional right ventricular shape in patients following tetralogy of Fallot repair involving a transannular Patch

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/1532-429x-18-s1-p182 ◽

2016 ◽

Vol 18 (S1) ◽

Author(s):

Amita Singh ◽

Anuj Mediratta ◽

Francesco Maffessanti ◽

Shelby Kutty ◽

Victor Mor-Avi ◽

...

Keyword(s):

Right Ventricular ◽

Tetralogy Of Fallot ◽

Transannular Patch ◽

Tetralogy Of Fallot Repair

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Abstract 14576: Durability of Valve-sparing Tetralogy of Fallot Repair

Circulation ◽

10.1161/circ.142.suppl_3.14576 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Elizabeth H Stephens ◽

Bryan L Wolfe ◽

Abhinav A Talwar ◽

Angira Patel ◽

Joseph Camarda ◽

...

Keyword(s):

Tetralogy Of Fallot ◽

Pulmonary Valve ◽

Pulmonary Regurgitation ◽

Pulmonary Valve Replacement ◽

Patch Repair ◽

Transannular Patch ◽

Z Scores ◽

Valve Sparing ◽

Tetralogy Of Fallot Repair

Introduction: While valve-sparing repair is ideal for Tetralogy of Fallot (TOF), it’s durability and which patients may benefit from a transannular patch remains unclear. To this end, we reviewed our experience with valve-sparing TOF repair. Methods: Retrospective review was performed of all primary TOF operations at our institution from 1/2008 to 12/2018. Standard demographic, operative, and echo data were collected, along with clinical outcomes. Transannular patch and valve-sparing repair groups were then compared. Results: Sixty-eight patients underwent TOF repair with a mean age of 4.1±2.2 months and weight of 5.7±1.8 kg. There was no difference in age or weight between patients who underwent a transannular patch repair and valve-sparing repair (Table). There was also no difference in the frequency of hypercyanotic spells or beta-blocker use. As expected the pre-operative pulmonary valve size and z-score were significantly different between groups. Bypass times were longer in the transannular patch group (176±40 vs. 144±40 minutes, p=0.005). There were no differences in post-operative complications. At last follow-up (median 41.5 months) there was a trend of a higher peak pulmonary valve gradient (p=0.07) in the valve-sparing group, but no difference in pulmonary valve annulus z-scores. Additionally, the pulmonary valve z-scores in the valve-sparing group decreased from -2.3±1.0 on pre-discharge echocardiogram to -1.2±1.6 on last follow-up, with the peak gradient on pre-discharge 20 (33) mmHg stable on last follow-up at 18 (29) mmHg and degree of pulmonary regurgitation stable. There was one reoperation in the cohort: a pulmonary valve replacement in a patient who had undergone a transannular patch repair 6 years prior. Conclusions: Valve-sparing TOF patients demonstrated stable repairs with pulmonary valve growth, acceptable gradients, minimal regurgitation, and high freedom from re-intervention during follow-up.

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Risk factors for severe pulmonary regurgitation after repair of tetralogy of Fallot with transannular patch

Cardiology in the Young ◽

10.1017/s1047951120003170 ◽

2020 ◽

Vol 30 (12) ◽

pp. 1917-1922

Author(s):

Putria Rayani Apandi ◽

Rubiana Sukardi ◽

Mulyadi M. Djer ◽

Piprim B. Yanuarso ◽

Suprayitno Wardoyo

Keyword(s):

Risk Factors ◽

Confidence Interval ◽

Right Ventricular ◽

Tetralogy Of Fallot ◽

Odds Ratio ◽

Pulmonary Regurgitation ◽

Transannular Patch ◽

Repaired Tetralogy Of Fallot ◽

Tetralogy Of Fallot Repair

AbstractBackground:Severe pulmonary regurgitation may result in right ventricular volume overload and decreased right ventricular function. Severe pulmonary regurgitation can be predicted prior to repair of tetralogy of Fallot. The aim of this study was to determine the risk factors for severe pulmonary regurgitation in repaired tetralogy of Fallot with transannular patch.Methods:This was a cross-sectional study in 43 patients with repaired tetralogy of Fallot using transannular patch. This study was carried out in Dr. Cipto Mangunkusumo hospital during 2015 to 2018. Participants were followed up for routine examination using echocardiography. We used bivariate and multivariate logistic regression using STATA 12.1 to identify risk factors for severe pulmonary regurgitation in this population.Results:A total of 43 patients composed of 22 boys and 21 girls with repaired tetralogy of Fallot using transannular patch were enrolled in the study. Median age of participants was 6 years at admission (2.1–18.5 years) and 3.4 years (1–17 years) at repair. Median length of follow-up was 2.1(1–4.3) years. Risk factors associated with severe pulmonary regurgitation after tetralogy of Fallot repair were McGoon ratio > 1.8 (odds ratio = 6.9; 95% confidence interval = 1.6–30) and follow-up duration >1.9 years (odds ratio = 3.6; 95% confidence interval = 0.9–15.2).Conclusion:McGoon ratio > 1.8 and follow-up duration > 1.9 years are associated with severe pulmonary regurgitation after tetralogy of Fallot repair.

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Value of pulmonary annulus index in predicting transannular patch in tetralogy of Fallot repair

10.22541/au.161326593.36438769/v1 ◽

2021 ◽

Author(s):

zhenyu lyu ◽

mei jin ◽

yifei yang

Keyword(s):

Pulmonary Artery ◽

Tetralogy Of Fallot ◽

Area Under Curve ◽

Roc Analysis ◽

Main Pulmonary Artery ◽

Radical Operation ◽

Z Score ◽

Cutoff Value ◽

Transannular Patch ◽

Tetralogy Of Fallot Repair

Objective: It is very important to accurately assess the transannular patch (TAP) in the surgical treatment of tetralogy of Fallot（TOF）. Methods: 130 patients who were diagnosed with TOF and underwent TOF repair. 112 cases were included in this study. They were divided into TAP group and no TAP group; the values of pulmonary annulus and aortic annulus were measured. GA ratio, PAI, PAAI, the pulmonary annulus Z-score and main pulmonary artery (MPA) Z-score were calculated to do statistically analyze. Results: A total of 112 patients were included in the study.62 cases (55.8%) did not transannular patch, 50 cases (44.2%) undergoing transannular patch. The pulmonary annulus Z-score, main pulmonary artery Z-score and PAI in TAP group were smaller than those in no TAP group (P < 0.05). ROC analysis showed that when the cutoff value of pulmonary annulus at -1.98 ,the area under curve (AUC) was 0.88, the sensitivity was 80%, the specificity was 71%; when the cut-off value of PAI at 0.53 ,AUC was 0.85, the sensitivity was 75%, the specificity was 80%; when the cutoff value of GA ratio at 0.55 ,AUC was 0.85, the sensitivity was 76%, and the specificity was 80%. The area under the PAAI curve (AUC) was 0.85, the sensitivity was 76%, and the specificity was 79%. Conclusion: The predictive effect of pulmonary annulus index as a simple and effective predictor of TAP in TOF radical operation is the same as that of pulmonary annulus Z-score.

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