Sustained Improvement in Right Ventricular Chamber Dimensions 10 Years Following Xenograft Pulmonary Valve Replacement

2016 ◽  
Vol 8 (1) ◽  
pp. 39-47 ◽  
Author(s):  
Heidi B. Schubmehl ◽  
Michael F. Swartz ◽  
Nader Atallah-Yunes ◽  
Carol Wittlieb-Weber ◽  
Rebecca E. Pratt ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Pulmonary Valve Replacement ◽  
Sustained Improvement ◽  
Z Scores ◽  
Valved Conduit ◽  
One Year ◽  
The Right

Background: The goals following pulmonary valve replacement (PVR) are to optimize right ventricular hemodynamics and minimize the need for subsequent reoperations on the right ventricular outflow tract. We hypothesized PVR using a xenograft valved conduit would result in superior freedom from reoperation with sustained improvement in right ventricular chamber dimensions. Methods: Xenograft valved conduits placed in patients aged >16 years were reviewed from 2000 to 2010 to allow for a 5-year minimum follow-up. Preoperative, one-year, and the most recent echocardiograms quantified right ventricular chamber dimensions, corresponding Z scores, and prosthetic valve function. Magnetic resonance imaging (MRI) studies compared preoperative and follow-up right ventricular volumes. Results: A total of 100 patients underwent PVR at 24 (19-34) years. Freedom from reintervention was 100% at 10 years. At most recent follow-up, only one patient had greater than mild pulmonary insufficiency. The one-year (17.3 ± 7.2 mm Hg; P < .01) and most recent follow-up (18.6 ± 9.8 mm Hg; P < .01) Doppler-derived right ventricular outflow tract gradients remained significantly lower than preoperative measurements (36.7 ± 27.0 mm Hg). Similarly, right ventricular basal diameter, basal longitudinal diameter, and the corresponding Z scores remained lower at one year and follow-up from preoperative measurements. From 34 MRI studies, the right ventricular end-diastolic indexed volume (161.7 ± 58.5 vs 102.9 ± 38.3; P < .01) and pulmonary regurgitant fraction (38.0% ± 15.9% vs 0.8% ± 3.3%; P < .01) were significantly lower at 7.1 ± 3.4 years compared to the preoperative levels. Conclusion: Use of a xenograft valved conduit for PVR results in excellent freedom from reoperation with sustained improvement in right ventricular dimensions at an intermediate-term follow-up.

Transcatheter closure of defects within the oval fossa using the Amplatzer® Septal Occluder

2002 ◽  
Vol 12 (3) ◽  
pp. 224-228 ◽  
Author(s):  
Haifa Abdul Latiff ◽  
Mazeni Alwi ◽  
Hasri Samion ◽  
Geetha Kandhavel
Keyword(s):  
Transcatheter Closure ◽  
Standard Procedure ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Term Outcome ◽  
Long Term Follow Up ◽  
One Year ◽  
The Right

This study reviewed the short-term outcome of transcatheter closure of the defects within the oval fossa using an Amplatzer® Septal Occluder. From January 1997 to December 2000, 210 patients with defects within the oval fossa underwent successful transcatheter closure. We reviewed a total of 190 patients with left-to-right shunts, assessing the patients for possible complications and the presence of residual shunts using transthoracic echocardiogram at 24 h, 1 month, 3 months and one year. Their median age was 10 years, with a range from 2 to 64 years, and their median weight was 23.9 kg, with a range from 8.9 to 79 kg. In 5 patients, a patent arterial duct was closed, and in 2 pulmonary balloon valvoplasty performed, at the same sitting. The median size of the Amplatzer® device used was 20 mm, with a range from 9 to 36 mm. The median times for the procedure and fluoroscopy were 95 min, with a range from 30 to 210 min, and 18.4 min, with a range from 5 to 144 min, respectively. Mean follow-up was 20.8 ± 12.4 months. Complete occlusion was obtained in 168 of 190 (88%) patients at 24 h, 128 of 133 (96.2%) at 3 months, and 103 of 104 (99%) at one year. Complications occurred in 4 (2.1%) patients. In one, the device became detached, in the second the device embolized into the right ventricular outflow tract, the lower end of the device straddled in the third, and the final patient had significant bleeding from the site of venupuncture. There were no major complications noted on follow-up. We conclude that transcatheter closure of defects within the oval fossa using the Amplatzer® Septal Occluder is safe and effective. Long-term follow-up is required, nonetheless, before it is recommended as a standard procedure.

Congenital right atrial diverticulum, atrial septal defect within the oval fossa, and complex pulmonary valvar obstruction in an infant with chromosome 8(p23.1) deletion

2005 ◽  
Vol 15 (3) ◽  
pp. 306-308 ◽  
Author(s):  
Aungkana Gengsakul ◽  
Suvro S. Sett ◽  
Martin C. K. Hosking
Keyword(s):  
Right Ventricular ◽  
Septal Defect ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Chromosome 8 ◽  
Right Atrial ◽  
Ventricular Compliance ◽  
The Right ◽  
Right Atrial Aneurysm

We describe an unusual right atrial aneurysm, occurring with progressive obstruction of the right ventricular outflow tract and increasing cyanosis, in a nine-month-old boy with chromosome 8(p23.1) deletion. Surgical resection of the diverticulum, and relief of the right ventricular obstruction, was successful, although impairment of right ventricular compliance persists after 19 months follow-up.

Restrictive right ventricular performance assessed by cardiac magnetic resonance after balloon valvuloplasty of critical pulmonary valve stenosis

2015 ◽  
Vol 26 (3) ◽  
pp. 556-568 ◽  
Author(s):  
Ikram Massoud ◽  
Nader Botros ◽  
Atef Yehia ◽  
Hassan Abdelghafoor ◽  
Mohamed Donya ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
Right Ventricular ◽  
Pulmonary Valve ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Balloon Valvuloplasty ◽  
Pulmonary Valve Stenosis ◽  
Gadolinium Enhancement ◽  
The Right

AbstractBackgroundLittle data are published about right ventricular diastolic performance in patients with critical pulmonary valve stenosis after balloon pulmonary valvuloplasty thus far.MethodsA total of 44 patients with isolated critical pulmonary valve stenosis who had undergone balloon valvuloplasty with haemodynamic recordings were enrolled to the study; 33 patients who came for follow-up underwent further imaging by echocardiography after 6 months and their right ventricular functional parameters were compared with 33 control patients of the same age and sex. Out of 33 patients, 21 underwent cardiac MRI with late gadolinium enhancement to assess the presence of right ventricular fibrosis.ResultsThe right ventricular systolic pressure (p<0.0001) and right ventricular outflow tract gradient (p<0.0001) decreased acutely (p<0.0001) after balloon valvuloplasty. During follow-up, M-mode left ventricular end diastolic dimension (p<0.001) and end systolic dimension increased (p<0.001), whereas right ventricular end diastolic dimension decreased (p<0.001). Compared with controls, patients (n=33) had significantly reduced tricuspid annular Ea and higher E/Ea (p<0.001). Right ventricular systolic dysfunction was also suggested by reduced tricuspid annular systolic velocity (p<0.001). Late gadolinium enhancement was demonstrated in 13 out of 21 patients with restrictive physiology, which involves the anterior right ventricular outflow tract, anterior wall, and inferior wall. The right ventricular late gadolinium enhancement score correlated positively with age (r=0.7, p<0.001) and right ventricular mass index (r=0.52, p<0.001).ConclusionThe persistence of right ventricular diastolic dysfunction after relief of chronic pressure overload of critical pulmonary valve stenosis suggests that a factor – other than increase in afterload – is involved in this physiology. Fibrosis is the most likely factor responsible for persistence of restrictive physiology as documented by late gadolinium enhancement.

scholarly journals Different conduits for the right ventricular outflow tract reconstruction in adults during the Ross procedure

2015 ◽  
Vol 17 (2) ◽  
pp. 23 ◽  
Author(s):  
A. M. Karaskov ◽  
I. I. Demin ◽  
R. M. Sharifulin ◽  
S. I. Zheleznev ◽  
A. V. Bogachev-prokofev ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Multivariable Analysis ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Ross Procedure ◽  
Acceptable Alternative ◽  
The Right ◽  
Pulmonary Homograft

We compared different conduits for the right ventricular outflow tract reconstruction (RVOT) in adults during the Ross procedure. Between 1998 and 2012, 586 consecutive adult patients underwent the Ross procedures. Mean age was 45,514,2 years. The RVOT was reconstructed with a diepoxy-treated xenografts in 372 and with glutaraldehyde-treated in 88 patients. A pulmonary homograft was used in 125 patients. Hospital mortality was 4,9%. Mean follow up was 43,216,9 months. At discharge systolic gradient was 8,1 3,7 mm.Hg for the pulmonary homograft, 11,44,7 mm.Hg for the diepoxytreated and 14,96,1 mm.Hg for the glutaraldehyde-treated xenopericardial conduits. Twenty eight patients underwent reoperation. The 3-year actuarial freedom from conduit explantation for pulmonary homograft was 100%, for diepoxy- and glutaraldehyde-treated xenopericardial conduits 99,20,7% and 84,74,7% respectively. Multivariable analysis identified the type of xenograft and age as independent factors for xenograft dysfunction. Results from this study show that the pulmonary homograft is the most preferred conduit for the RVOT reconstruction during the Ross procedure. The diepoxy-treated xenopericardial conduits are acceptable alternative to the homograft in patients older 45 years.

scholarly journals Late Follow-Up of Rastelli Operation After One-Stage Repair with Right Ventricular Remodeling

2021 ◽  
pp. 1-4
Author(s):  
Miguel Maluf
Keyword(s):  
Coronary Artery ◽  
Right Ventricular ◽  
Ventricular Remodeling ◽  
Pulmonary Atresia ◽  
Right Ventricular Outflow Tract ◽  
Peripheral Oxygen Saturation ◽  
One Stage ◽  
Valved Conduit ◽  
The Right

We report long-term outcomes after one-stage, surgical repair, at an 11-year-old, girl with pulmonary atresia with a ventricular septal defect and anomalous origin of the left coronary artery from the right coronary artery, crossing the right ventricular outflow tract. The operation was carried out with the remodeling of the right ventricle, using a swine valved conduit prosthesis (22mm). Twenty-nine years later, the patient is in excellent clinical condition, CF I (NYHA), with normal peripheral oxygen saturation. Recent invasive and not invasive imaging show: the absence of intracardiac shunt, despite presenting prosthesis calcification and signs of mild double lesion of the prosthetic valve. The pulmonary flow is directed uniformly for both lungs. Patients undergoing the implantation of valved conduits during childhood, present mismatch, after a few years of follow-up, and are required to undergo frequent reoperations. In this patient, the indication of a Blalock-Taussig shunt, during childhood, allowed to postpone the surgery and implant a valved conduit with a larger diameter, achieving a long follow-up with a single prosthetic implant.

scholarly journals Outcome of the Repair of Double-Chambered Right Ventricle: A single centre experience

2016 ◽  
Vol 8 (2) ◽  
pp. 165-168
Author(s):  
Mohammad Rokonujjaman ◽  
Md Shaheedul Islam ◽  
Md Sirajul Islam ◽  
Sheikh Mahamoudh ◽  
Md Jasim Uddin ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Right Ventricular ◽  
Surgical Repair ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Pressure Gradients ◽  
Anomalous Muscle ◽  
Single Centre Experience ◽  
The Right

Background: The presence of anomalous muscle bundles may pro-duce a pressure gradient between the inflow and outflow portions of the right ventricle, resulting in double-chambered right ventricle. We reviewed the outcomes of double chambered right ventricle surgical repair.Methods: Between December 2012 and January 2014, 6 patients under went surgical repair of a double-chambered right ventricle. The patients ranged in age from 3 years to 20 years (mean 8.2±5.9 yrs). Right ventricular outflow tract pressure gradients were from 60 to 120 mm Hg (mean 63.3±40.3). An associated ventricular septal defect was present in 4 patients (66.66%).Results: There were no hospital or late deaths. Mean postsurgical follow up was 3.8±0.8 months). No patient required further surgery to relieve obstruction of right ventricular outflow tract.Conclusions: Surgical repair of a double chambered right ventricle yield excellent hemodynamic and functional results.Cardiovasc. j. 2016; 8(2): 165-168

scholarly journals Right Ventricular Outflow Tract Stenting as Palliation of Critical Tetralogy of Fallot: Techniques and Results

Hearts ◽  
2021 ◽  
Vol 2 (2) ◽  
pp. 278-287
Author(s):  
Alessandra Pizzuto ◽  
Magdalena Cuman ◽  
Nadia Assanta ◽  
Eliana Franchi ◽  
Chiara Marrone ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Pulmonary Blood Flow ◽  
Pulmonary Valve ◽  
Primary Repair ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Surgical Palliation ◽  
Early Primary ◽  
The Right

Background. Despite current trends toward early primary repair, the surgical systemic-to-pulmonary shunt is still considered the first-choice palliation in patients with critical tetralogy of Fallot (TOF) and duct-dependent pulmonary circulation unsuitable for primary repair. However, stenting of the right ventricular outflow tract (RVOT) is nowadays emerging as an effective alternative to surgical palliation in selected patients. Methods and results. RVOT stenting is usually performed from a venous route, either femoral or, in selected cases, the right internal jugular vein. Less frequently, mostly in pulmonary infundibular/valvar atresia, this procedure can be performed using a hybrid surgical/interventional approach by surgical exposure of the RVOT, puncture of the atretic valve, and stent deployment under direct vision. The size and type of the most appropriate stent may be chosen, based on ultrasound measurements of the RVOT, to cover the right ventricular infundibulum completely and, at the same time, sparing the pulmonary valve, unless significant pulmonary valve annulus hypoplasia and/or supra-valvular stenosis is a significant component of the obstruction. In the large series so far published, early mortality of RVOT stenting is less than 2%, comparing favourably with either Blalock-Thomas-Taussig shunt or early primary repair. In addition, morbidity and clinical sequelae of this approach do not significantly differ from surgical palliation, even if RVOT stenting shows lesser durability and a higher rate of trans-catheter re-interventions over a mid-term follow-up. Finally, similar but more balanced pulmonary artery growth than surgical palliation following RVOT stenting is reported over a mid-term follow-up. Conclusions. RVOT stenting is a technically feasible, well-tolerated, and effective palliation in critical TOF. This approach is cost-effective with respect to surgical palliation either in high-risk neonates or whenever a short-term pulmonary blood flow source is anticipated due to the early surgical repair. It effectively increases pulmonary blood flow, improves arterial saturation, and promotes balanced pulmonary artery growth over a mid-term follow-up.

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