Unexpected Internalization of a Pulmonary Artery Band in a Porcine Model of Tetralogy of Fallot

2016 ◽  
Vol 8 (1) ◽  
pp. 48-54 ◽  
Author(s):  
Zakaria Jalal ◽  
François Roubertie ◽  
Emmanuelle Fournier ◽  
Virginie Dubes ◽  
David Benoist ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Tetralogy Of Fallot ◽  
Histological Analysis ◽  
Porcine Model ◽  
Pulmonary Stenosis ◽  
Main Pulmonary Artery ◽  
Pulmonary Regurgitation ◽  
Inflammatory Cells ◽  
Pulmonary Insufficiency ◽  
Unusual Complication

Background: We report our experience of an unexpected complication of internalization of a pulmonary artery (PA) band in the vascular lumen, which occurred in a chronic porcine model of repaired tetralogy of Fallot (TOF). Methods: Twelve piglets were divided into 3 groups: (1) TOF model animals (PA band plus pulmonary valvotomy, n = 4), (2) pulmonary insufficiency (PI) animals (pulmonary valvotomy, n = 4), and (3) control animals (n = 4). A nonabsorbable, coated braided polyester tape was used to perform the main pulmonary artery banding. Echocardiography was performed 4 months postoperatively. After each animal was euthanized, PA histological analysis was performed in animals with band internalization. Results: Significant postsurgical pulmonary regurgitation and right ventricular enlargement were present in the TOF and PI, compared with control animals, whereas no significant pulmonary stenosis was observed in TOF animals when compared with PI group. Postmortem examination of all TOF animals revealed the constricting band to be intact but partially internalized into the PA lumen, allowing blood flow around the stenosis. Histological sections of the banded PA in the area of internalization showed a significant disorganization of the medial layer, with significant scarring and fibrotic reaction surrounding the outside of the band and the presence of inflammatory cells suggesting a significant inflammatory response during band internalization. Conclusions: Band internalization may occur after PA banding using a nonabsorbable, coated braided polyester tape in a chronic porcine model of repaired TOF. This unusual complication was likely due to the type of material used for banding.

Assessment of Right Ventricular Inefficiency Using Energy Transfer Ratio in Repaired Tetralogy of Fallot

2011 ◽  
Author(s):  
Namheon Lee ◽  
Ashish Das ◽  
William M. Gottliebson ◽  
Rupak K. Banerjee
Keyword(s):  
Energy Transfer ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Main Pulmonary Artery ◽  
Pulmonary Regurgitation ◽  
Pulmonary Insufficiency ◽  
Control Group ◽  
Stroke Work ◽  
Transfer Ratio ◽  
Repaired Tetralogy Of Fallot

Pulmonary insufficiency (PI) induces pulmonary regurgitation and often leads to right ventricular (RV) enlargement and RV pressure overloading in repaired Tetralogy of Fallot (rTOF) patients. The appropriate timing of surgical treatments to renormalize RV function remains uncertain due to lack of suitable clinical diagnostic parameters. An energy transfer ratio (eMPA) between the net energy (Enet) transferred at main pulmonary artery (MPA) from RV and stroke work (SW) by RV was calculated using RV volume and pressure data for subjects in two study groups: the rTOF patient group (n = 7) and the control group (n = 7). Statistical analysis was performed to determine the difference of eMPA between the two groups. The mean eMPA for rTOF patients (0.64) was significantly lower (60.2%, p<0.05) than that of controls (1.61).

P268 Anomalies of pulmonary arteries in Tetralogy of Fallot in developing countries: study of 100 cases in indian population

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
A Tiwari ◽  
PARAG Barwad ◽  
U M A Dabi
Keyword(s):  
Pulmonary Artery ◽  
Aortic Arch ◽  
Tetralogy Of Fallot ◽  
Surgical Management ◽  
Pulmonary Valve ◽  
Pulmonary Stenosis ◽  
Main Pulmonary Artery ◽  
Pulmonary Arteries ◽  
Great Vessels ◽  
Pulmonary Artery Abnormalities

Abstract Introduction Right ventricular outflow tract (RVOT) obstruction in some or other form is one of the major components of Tetralogy of Fallot. It can occur at any level, isolated or in combination, from Infundibulum (most common), Pulmonary valve, Main pulmonary artery, Right and Left pulmonary arteries and up to their segmental branches. Incidence of pulmonary artery anomalies are reported between 15-20%, though some reported as high as 40%.  Purpose  The objective of this retrospective  observational study is to determine the presence and degree of pulmonary artery  abnormalities and associated cardiac defects in patients with Tetralogy of Fallot and to  define the pulmonary arterial anatomy to guide the further surgical management. Method A total of 100 newly diagnosed or follow up cases of TOF irrespective of age (range 5 days- 32 years) and gender (32 female, 68 male) who were planned for surgical management and referred for evaluation of pulmonary artery anatomy. All patient underwent non-ECG gated CT pulmonary Angiography in Toshiba 64 slice CT scanner.  CT data was analyzed retrospectively to look for cardiac and pulmonary artery anatomy by one independent observer having experience in cardiac radiology. Results 92 patient had infundibular and valvular stenosis and 8 patients has atretic pulmonary valve with additional supravalvar pulmonary stenosis in 17% patient. Out of total 100 patients, 35% had pulmonary artery abnormalities. This included 19 patient (19%) with isolated main pulmonary artery (MPA) abnormality, 6 % had isolated left pulmonary artery (LPA) abnormality, 2 had isolated right pulmonary artery abnormality, 4% had  combined MPA and LPA  abnormality, 2% had combined MPA and RPA abnormalities and 1% patient had all 3 (MPA,LPA,RPA) involvement in form of stenosis or hypoplasia. As TOF is commonly associated with other cardiac structural anomalies, we encountered following associations in our study – aortopulmonary collaterals (37%), Patent ductus arteriosus (29%), right sided aortic arch (19%), bilateral superior vena cava (10%), bovine arch (3%), double aortic arch (2%), d malposition of great vessels (2%), l malposition of great vessels (1%), situs inversus (1%), dextrocardia (1%), annuloaortic ectasia (1%) aortopulmonary window (1%) and cardiac totally anomalous pulmonary venous connection (1%). Conclusions Anomalies of pulmonary arteries are important determinant of surgical outcome of TOF patients. CT angiography is now established modality to delineate pulmonary artery and other anatomical details in TOF patient. Pulmonary artery anomaly can range from isolated branch pulmonary stenosis to diffuse hypoplasia of pulmonary vasculature, based on which management can differ from complete correction to palliative or medical management only. Our study emphasize the importance of pulmonary artery evaluation and its variation among patients of TOF. Abstract P268 Figure.

scholarly journals Mid- to long-term follow-up of pulmonary valve replacement with BioIntegral injectable valve

2020 ◽  
Author(s):  
Simone Ghiselli ◽  
Cristina Carro ◽  
Nicola Uricchio ◽  
Giuseppe Annoni ◽  
Stefano M Marianeschi
Keyword(s):  
Cardiopulmonary Bypass ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Stenosis ◽  
Pulmonary Regurgitation ◽  
Pulmonary Valve Replacement

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.

Abstract 12430: Vicious Circle Between Progressive Right Ventricular Dilatation and Pulmonary Regurgitation in Patients After Tetralogy of Fallot Repair? Right Heart Enlargement Promotes Flow Reversal in the Left Pulmonary Artery

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Atsuko Kato ◽  
Christian Drolet ◽  
Shi-Joon Yoo ◽  
Andrew Redington ◽  
Lars Grosse-Wortmann
Keyword(s):  
Pulmonary Artery ◽  
Tetralogy Of Fallot ◽  
Left Lung ◽  
Pulmonary Regurgitation ◽  
Left Pulmonary Artery ◽  
Flow Reversal ◽  
Left Hemithorax ◽  
Forward Flow ◽  
Lung Area ◽  
The Right

Introduction: The left pulmonary artery (LPA) contributes more than the right (RPA) to total pulmonary regurgitation (PR) in patients after tetralogy of Fallot (TOF) repair, but the mechanism of this difference is not well known. We hypothesized that unilaterally increased pulmonary vascular resistance (PVR), resulting from lung compression by the enlarged and levorotated heart leads to greater PR in the LPA. This study aimed to analyze the interplay between heart and lung size, mediastinal geometry, and differential PR. Methods: This is a single-center retrospective analysis of 50 magnetic resonance studies in patients after TOF repair. Patients with more than mild discrete branch pulmonary artery stenosis were excluded. Blood flow was measured by phase-contrast velocity encoding within the branch pulmonary arteries. On the axial image with the largest total cardiac surface area, cardiac angle (α) between the thoracic anterior-posterior line and the interventricular septum, right and left lung areas as well as right and left hemithorax areas were measured (Figure). Results: There was no difference in LPA and RPA diameters. The LPA showed significantly less total forward flow (p=0.04), smaller net forward flow (p=<0.001), and greater RF (p=0.001) than the RPA. Left lung area was smaller than the right (p<0.001). RVEDVi correlated with LPA RF (R=0.48, p<0.001), but not with RPA RF. Larger RVEDVi correlated with a larger α angle (R=0.46, p<0.001), i.e. a more leftward cardiac axis and with smaller left lung area (R=-0.58, p<0.001). LPA RF, but not RPA RF, correlated inversely with left lung area indexed to the left hemithorax area (R=-0.34, p=0.02). Conclusions: An enlarged and levorotated heart - as a result of PR - is associated with smaller left lung size, and augments diastolic flow reversal in the LPA, presumably via increased left PVR. By imposing a further volume load on the RV, LPA regurgitation may thus close a positive feed-back loop of PR and RV dilatation.

Abstract 3123: Doppler Echocardiography Reliably Predicts Severe Pulmonary Regurgitation (PR) As Quantified by Cardiac Magnetic Resonance (CMR)

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Pierangelo Renella ◽  
Jamil Aboulhosn ◽  
Derek G Lohan ◽  
Praveen Jonnala ◽  
J. P Finn ◽  
...  
Keyword(s):  
Doppler Echocardiography ◽  
Pulmonary Stenosis ◽  
Univariate Analysis ◽  
Main Pulmonary Artery ◽  
Pulmonary Arteries ◽  
Pulmonary Regurgitation ◽  
Regression Tree ◽  
Color Flow ◽  
Gold Standard Method ◽  
Good Individual

Background: Significant PR is a common sequel to repair of some forms of congenital heart disease (CHD). Grading the severity of PR by Doppler echocardiography (echo-Doppler) is not standardized and may be problematic. CMR is considered the gold standard method for quantifying PR, but is not universally available. We sought to determine the best echo-Doppler predictors of severe PR. Methods & Results: We retrospectively reviewed 36 CHD pts (median age 31 yrs, range 10 – 67 yrs; 33 with Tetralogy of Fallot, 3 with primary pulmonary stenosis) with prior pulmonary valvuloplasty and/or transannular patch placement who underwent both Doppler echo and velocity encoded CMR. Severe CMR PR was defined as ≥40% regurgitant fraction. Echo-Doppler measurements used to predict severe PR were: diastolic flow reversal (DFR) of color flow or spectral pulsed wave Doppler in the main pulmonary artery (MPA) or the branch pulmonary arteries (BPA), a PR jet that fills ≥50% of the pulmonary annular diameter (PAD), PR pressure half-time (PHT) <100 msec, & pulmonary regurgitation index (PRi) <0.77. MPA DFR had 100% sensitivity but low specificity (39%) for detecting severe PR (Table 1 ). BPA DFR remained quite sensitive (87%), but much more specific (87%). Univariate analysis showed each variable (except PRi) was a good individual predictor of severe PR (Table 2 ). Classification & regression tree analysis showed the 2 most useful variables were (first) DFR in the BPA & (second) the PRi <0.77. Conclusions: Readily obtained targeted echo-Doppler measurements reliably identify severe PR as quantified by CMR. BPA DFR is the most specific and MPA DFR is the most sensitive echo-Doppler finding for detecting severe PR. Table 1. Statistical Analysis of 5 Echo-Doppler Measures Table 2. Univariate Analysis of 5 Echo-Doppler Measures

Congenital isolated absence of a single cusp of pulmonary valve

2021 ◽  
pp. 021849232110609
Author(s):  
Niraj Nirmal Pandey ◽  
Mumun Sinha ◽  
Arun Sharma ◽  
Ambuj Roy
Keyword(s):  
Computed Tomography ◽  
Pulmonary Valve ◽  
Heart Defects ◽  
Cardiac Computed Tomography ◽  
Main Pulmonary Artery ◽  
Pulmonary Regurgitation ◽  
Pulmonary Insufficiency ◽  
Cardiac Computed Tomography Angiography ◽  
Arterial Circulation ◽  
Pulmonary Arterial

A 25-year-old, previously asymptomatic female, presented to the outpatient clinic with episodic palpitations for past 6 months. She was acyanotic and showed no peripheral stigmata of infective endocarditis. Transthoracic echocardiography revealed dilated right ventricle with severe low-pressure pulmonary regurgitation. A cardiac computed tomography angiography performed for evaluation of pulmonary arterial circulation and intracardiac anatomy revealed isolated absence of posterior pulmonary cusp. The two other (right anterior and left anterior) cusps were normal and covered only part of the valve orifice, resulting in pulmonary insufficiency. The main pulmonary artery showed asymmetric dilatation. No other structural heart defects were noted.

Intermediate Outcomes of Staged Tetralogy of Fallot Repair

2019 ◽  
Vol 10 (6) ◽  
pp. 694-701 ◽  
Author(s):  
Poonam Mahajan ◽  
Eric S. Ebenroth ◽  
Kirsten Borsheim ◽  
Sabena Husain ◽  
Na Bo ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Tetralogy Of Fallot ◽  
Pulmonary Valve ◽  
Surgical Intervention ◽  
Main Pulmonary Artery ◽  
Postoperative Arrhythmia ◽  
Young Infants ◽  
Intermediate Outcomes ◽  
Valve Annulus ◽  
Early Surgical Intervention

Background: The optimal surgical strategy for tetralogy of Fallot (TOF) repair in neonates and young infants requiring early surgical intervention remains controversial. Our surgical center follows the uniform strategy of a staged approach with initial systemic-to-pulmonary artery shunt the majority of time when early surgical intervention is required. We characterized a contemporary cohort of patients with TOF with pulmonary stenosis (PS) undergoing staged repair in order to determine the rate of pulmonary valve-sparing repair (PVSR), growth of the pulmonary valve annulus and pulmonary arteries, postoperative morbidity and mortality, and need for reintervention. Methods: We retrospectively studied patients with TOF/PS who underwent staged repair from 2000 to 2017. Surgical details, postoperative course, and reinterventions were noted. Echocardiographic measurements and Z-score values of pulmonary valve annulus, main pulmonary artery (MPA), right pulmonary artery (RPA), and left pulmonary artery (LPA) diameters were evaluated. Results: Of the 59 patients with staged TOF/PS, PVSR was performed in 25 (42%). There was a 5% incidence of postoperative arrhythmia. The Z-scores of MPA, RPA, and LPA were significantly higher before complete repair when compared to before palliative shunt. The 5 and 10-year survival rates were both 93%, and the probability of freedom from reoperation at 5 and 10 years was 87% and 82%, respectively. Conclusions: Staged repair of TOF in young symptomatic infants results in 42% receiving PVSR, pulmonary artery growth, low incidence of postoperative arrhythmia, and relatively low rate of reoperations.

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