Pulmonary Valve Insufficiency as a Complication of Radical Surgical Treatment of Tetralogy of Fallot

Summary Tetralogy of Fallot is the most common cyanogenic congenital heart defect. The diagnosis is based on clinical signs, ECG examination, ultrasound examination of the heart, additional imaging methods and invasive testing. The therapeutic approach to the patient with tetralogy is complex and based on conservative and radical methods. Patients who have not undergone a radical surgical intervention have a poor prognosis, whereas the prognosis is much better for patients who have been operated. The most common complication of the surgical treatment is the pulmonary valve insufficiency which usually requires reintervention, as was the case with our patient.

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Chronic pulmonary valve insufficiency after repaired Tetralogy of Fallot: diagnostics, reoperations and reconstruction possibilities

Expert Review of Cardiovascular Therapy ◽

10.1586/14779072.5.2.221 ◽

2007 ◽

Vol 5 (2) ◽

pp. 221-230 ◽

Cited By ~ 8

Author(s):

Alexander Kadner ◽

Igor I Tulevski ◽

Urs Bauersfeld ◽

René Prêtre ◽

Emanuela R Valsangiacomo-Buechel ◽

...

Keyword(s):

Tetralogy Of Fallot ◽

Pulmonary Valve ◽

Repaired Tetralogy Of Fallot ◽

Pulmonary Valve Insufficiency ◽

Valve Insufficiency

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Pulmonary valve insufficiency in a case of tetralogy of Fallot after Brock's operation

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/s0022-5223(19)42054-0 ◽

1971 ◽

Vol 62 (3) ◽

pp. 436-441 ◽

Cited By ~ 1

Author(s):

Geraldo Verginelli ◽

José Martin ◽

Miguel Barbero Marcial ◽

Radi Macruz ◽

E.J. Zerbini

Keyword(s):

Tetralogy Of Fallot ◽

Pulmonary Valve ◽

Pulmonary Valve Insufficiency ◽

Valve Insufficiency

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Assessment of Energy Loss due to Pulmonary Valve Insufficiency in Tetralogy of Fallot Physiology Using Patient Specific Geometry

ASME 2010 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2010-19631 ◽

2010 ◽

Author(s):

Ashish Das ◽

William Gottliebson ◽

Madhra Karve ◽

Rupak K. Banerjee

Keyword(s):

Tetralogy Of Fallot ◽

Pulmonary Valve ◽

Normal Subjects ◽

Patient Specific ◽

Energy Losses ◽

Flow Data ◽

Pulmonary Valve Insufficiency ◽

Valve Insufficiency ◽

Specific Geometry

Right ventricular (RV) enlargement and pulmonary valve insufficiency (PI) are well-known, unavoidable long term sequelae encountered by patients who undergo tetralogy of Fallot (TOF) surgery. Energy losses in the pulmonary artery (PA) of TOF and normal subjects was calculated using patient specific geometry and pressure and flow data to develop quantifiable clinical diagnostic parameters. The TOF subject shows 35% higher energy losses than our normal subject.

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Rehabilitation of a Female Patient after Corrective Surgery for Tetralogy of Fallot

Acta Facultatis Medicae Naissensis ◽

10.1515/afmnai-2015-0030 ◽

2015 ◽

Vol 32 (4) ◽

pp. 293-299

Author(s):

Jovana Cvetković ◽

Dragan Đ Đorđević ◽

Milan Šljivić ◽

Marina Deljanin Ilić

Keyword(s):

Tetralogy Of Fallot ◽

Female Patient ◽

Pulmonary Valve ◽

Heart Defects ◽

Physical Exertion ◽

Young Female ◽

Palliative Surgery ◽

Cardiovascular Rehabilitation ◽

Pulmonary Valve Insufficiency ◽

Valve Insufficiency

Summary Herein we present a 25-year-old female patient with tetralogy of Fallot (TOF). This congenital heart defect is not very common, but it is the most common one among cyanotic heart defects. Treatment of the patients with TF is surgical, with palliative or curative (corrective) intent. Our patient underwent palliative surgery, definitive correction, and another surgery for pulmonary valve insufficiency. During cardiovascular rehabilitation, the patient was rhythmically stable, with excellent tolerance of physical exertion. Bearing in mind that this was a young female person who previously had had two spontaneous abortions, pregnancy was not absolutely contraindicated, although spontaneous abortion and pregnancy complications were more common in these patients.

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Evolving Solutions in the Surgical Treatment of Isolated Pulmonary Valve Stenosis

10.21203/rs.3.rs-244126/v1 ◽

2021 ◽

Author(s):

Sonia B. Albanese ◽

Matteo Trezzi ◽

Elena Pelliccione ◽

Francesca Gatta ◽

Alessia Del Pasqua ◽

...

Keyword(s):

Surgical Treatment ◽

Pressure Gradient ◽

Pulmonary Valve ◽

Balloon Valvuloplasty ◽

Pulmonary Valve Stenosis ◽

Mean Pressure ◽

Pulmonary Valve Insufficiency ◽

Valve Insufficiency ◽

Group 1

Abstract Background. Surgical treatment of isolated pulmonary valve stenosis in infants and children has evolved over the years, shifting from the original exclusive aim at lowering right ventricle pressure to the current concomitant focus on preserving pulmonary valve function. In our study, we sought to analyze the effect of such evolving philosophy on mid-term results.Methods. 123 consecutive patients were treated in our center between 07/1983 and 03/2019. Mean age and weight were 3.0 ± 0.36 years and 16.6 ± 1.7 kg, respectively. Patients were categorized into 2 groups based on the onset of sparing valve techniques (1995). Short- and long-term mortality, freedom from reintervention on the right outflow tract, transvalvular mean pressure gradient decrease and pulmonary valve insufficiency were analyzed.Results. Early mortality occurred exclusively before 1995 (Group 1, 3.76%, p=ns). Transvalvular mean pressure gradient decreased in the entire patient population (from 63.28 ± 12.9 mmHg to 16.46 ± 7.9 mmHg), but right outflow tract reintervention rate was greater in Group 1 (14.10% vs 2.3%, p = 0.04). At a mean follow-up interval of 4.9 ± 33 years, pulmonary valve insufficiency was severe in 2.47% of patients in Group 1, whereas it was mild to moderate in 33.3% of patients in Group 2, the latter having undergone unsuccessful percutaneous balloon valvuloplasty prior to surgery in the vast majority of cases (14/20 vs 6/22, p=0.023).Conclusions. Current pulmonary valve sparing techniques are associated with better results, both in terms of survival and freedom from re-intervention at follow-up. Balloon valvuloplasty prior to surgery may worsen operative results, promoting pulmonary insufficiency and therefore should probably be avoided in all patients in whom anatomical characteristics predict failure of percutaneous therapy.

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Efficacy and safety of balloon valvuloplasty as a treatment of choice for pulmonary stenosis in children and adolescents

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1410542p ◽

2014 ◽

Vol 142 (9-10) ◽

pp. 542-546

Author(s):

Vojislav Parezanovic ◽

Milan Djukic ◽

Sanja Dzelebdzic ◽

Tamara Ilisic ◽

Igor Stefanovic ◽

...

Keyword(s):

Congenital Heart ◽

Pulmonary Valve ◽

Heart Defects ◽

Pulmonary Stenosis ◽

Age Groups ◽

Balloon Valvuloplasty ◽

Pulmonary Artery Stenosis ◽

Pulmonary Valve Insufficiency ◽

Valve Insufficiency

Introduction. Pulmonary artery stenosis (PS) is a congenital heart defect which occurs in 10% of all congenital heart defects. Pulmonary balloon valvuloplasty (BVP) has been the treatment of choice of PS over the last 30 years. Objective. The purpose of this study was to evaluate the efficacy of this method based on middle-term hospital follow-up, and safety of BVP based on our experience. Methods. The study included 88 patients diagnosed with PS. The patients were divided into three groups based on the severity of the disease. Also, they were divided into two age groups in order to analyze the frequency of complications. Hemodynamic measurements and echocardiography results were recorded before, 24-36 hours after BVP and at the end of follow-up. Results. The studied group involved patients of average age 3.75?4.3 years (20 days to 17 years). Immediately after BVP a significant decrease of pressure gradient across the pulmonary valve (PV) was recorded in all patients; this result was similar in all 3 groups of patients regardless of the severity of stenosis (p<0.001). Complications of BVP occurred most commonly in children up to 12 months of age (ventricular tachycardia 4.5% and supraventricular tachycardia 6.8%). Pulmonary valve insufficiency after dilatation occurred in 6.6% of cases, and was most common in children aged up to 12 months. In 87 (98.9%) patients BVP was a definitive solution, and a significant residual stenosis was not recorded during follow-up. Conclusion. BVP is a safe and effective procedure in the treatment of isolated PS in children, regardless of the severity of stenosis but also regardless of patients? age.

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Cystic form of biliary atresia. Treatment experience

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care ◽

10.17816/psaic603 ◽

2020 ◽

Vol 10 (1) ◽

pp. 17-24

Author(s):

Irina I. Borisova ◽

Anatoliy V. Kagan ◽

Svetlana A. Karavaeva ◽

Aleksey N. Kotin

Keyword(s):

Surgical Treatment ◽

Bile Duct ◽

Common Bile Duct ◽

Biliary Atresia ◽

Bile Ducts ◽

Surgical Intervention ◽

Ultrasound Examination ◽

Duct Cyst ◽

Cystic Form ◽

The Common

Background. The cystic form of biliary atresia is a rare form of atresia of the biliary tract, which is a relatively favorable variant of the defect and can be diagnosed antenatally. In practice, it is important not only to suspect this diagnosis, but also to differentiate this variant of impaired development of the external bile duct from the cyst of the common bile duct. This is due to the difference in approaches and methods of surgical treatment of choledochal cysts and biliary atresia. Obliteration (atresia) of the bile ducts in the absence of timely surgical intervention quickly leads to the progression of cirrhosis and the development of liver failure. The method of choice in the treatment of AD is Kasai surgery, often palliative in nature, but allowing to delay the time until liver transplantation. The cyst of the common bile duct rarely requires early surgical treatment, and the risk of cirrhosis is significantly lower. Surgical intervention is aimed at removing the cyst and restoring the flow of bile by anastomosing the external bile ducts with the intestines, which is a radical method of treatment and leads to the recovery of the child. External similarity in ultrasound examination of the fetus and newborn baby of the cystic form of biliary atresia of the bile ducts with a cyst of the common bile duct does not always allow differentiation of one defect from another, which can lead to untimely correction of the defect and an unfavorable outcome. Aim. Demonstrate a rare type of biliary atresia. Materials and methods. Between 2001 and 2019, 33 patients with biliary atresia were treated in the Childrens City Multidisciplinary Clinical Specialized Center for High Medical Technologies in St. Petersburg, only two patients had a cystic form. Both children were initially treated as patients with bile duct cyst. Children were operated on at the age of 2 and 3.5 months. The first patient underwent surgery Kasai, the second hepaticoyunoanastomosis. Results. During the observation period (9 years and 4 years), the synthetic function of the liver is normal, and there are currently no indications for transplantation. Conclusion. If a fetus or a newborn with neonatal jaundice is detected during ultrasound examination of a cystic formation in the gates of the liver, it is very important to correctly and quickly make a differential diagnosis between the cystic form of biliary atresia of the biliary tract and the common bile duct cyst.

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Intermediate Outcomes of Staged Tetralogy of Fallot Repair

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135119874035 ◽

2019 ◽

Vol 10 (6) ◽

pp. 694-701 ◽

Cited By ~ 1

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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