scholarly journals Importance of pulmonary valve morphology for pulmonary valve preservation in tetralogy of Fallot surgery: comparison of the echocardiographic parameters

2020 ◽  
Vol 63 (5) ◽  
pp. 189-194
Author(s):  
Su Jin Choi ◽  
Jung Eun Kwon ◽  
Da Eun Roh ◽  
Myung Chul Hyun ◽  
Han Na Jung ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Pulmonary Valve ◽  
Aortic Annulus ◽  
Data Sets ◽  
Key Factors ◽  
Descending Aorta ◽  
Surgical Methods ◽  
Echocardiographic Parameters ◽  
Valve Annulus ◽  
Tissue Characteristics

Background: The decision to use transannular patching (TAP) during tetralogy of Fallot (TOF) repair depends on the pulmonary valve annulus size; the <i>z</i> score of the pulmonary annulus is the most commonly used predictor. However, definitive results are not obtained with <i>z</i> scores as different <i>z</i> score data sets are used for different parameters.Purpose: This study aimed to identify the echocardiographic and other key factors that warranted a change in the surgical method during TOF surgery.Methods: Sixty-two patients were enrolled and divided into a pulmonary valve (PV) preservation group and a TAP group. Their medical records were reviewed.Results: The <i>z</i> score for PV annulus (PVA), ratio of the PVA to aortic annulus size, and ratio of PVA to descending aorta (DAO) size were significantly different between the PV preservation and TAP groups (-1.72±1.52 vs. -3.07±1.94, <i>P</i>=0.004; 0.62±0.12 vs. 0.50±0.14, <i>P</i>=0.002; and 1.32±0.32 vs. 1.07±0.36, <i>P</i>= 0.008, respectively). For TAP repair, the PVA <i>z</i> score had a sensitivity of 65.4% and specificity of 73.1%, ratio of PVA to aortic annulus size had a sensitivity of 73.1% and specificity of 65.4%, and ratio of PVA to DAO size had a sensitivity of 69.2% and specificity of 57.7%. The TAP group showed more monocuspid PVs (<i>P</i>=0.011), while the PV preservation group showed more tricuspid PVs (<i>P</i>=0.027). Commissurotomy was more frequently performed in the PV preservation group than in the TAP group (<i>P</i>=0.001). Of patients with commissurotomy, 58% showed a PV <i>z</i> score<-2.Conclusion: Although various echocardiographic parameters may serve as predictors for determining surgical methods for TOF patients, the PV morphology and tissue characteristics should also be considered.

Evolving Techniques for the Achievement of Optimal Long-Term Results After Tetralogy of Fallot Repair

2021 ◽  
Vol 12 (1) ◽  
pp. 116-123
Author(s):  
Giovanni Stellin ◽  
Alvise Guariento ◽  
Vladimiro L. Vida
Keyword(s):  
Tetralogy Of Fallot ◽  
Balloon Dilatation ◽  
Pulmonary Valve ◽  
Long Term Results ◽  
Complex Congenital Heart Disease ◽  
Valve Reconstruction ◽  
Valve Annulus ◽  
Teaching Cases ◽  
Tetralogy Of Fallot Repair

Several techniques designed to improve long-term results after repair of tetralogy of Fallot are described. We have recently embarked on a program focused on preserving the native pulmonary valve. Here, combined techniques are described in detail, including intraoperative pulmonary valve balloon dilatation, pulmonary valve reconstruction by delamination and resuspension of the leaflets, and pulmonary valve annulus augmentation. As with any other complex congenital heart disease, senior surgeons should select teaching cases, starting from the less severe side of the spectrum.

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.

scholarly journals Total Correction of Tetralogy of Fallot: Effect of Transannular Patch on Early Outcome

2018 ◽  
Vol 10 (2) ◽  
pp. 194-200 ◽  
Author(s):  
Md Azizul Islam Khan ◽  
Kazi Abul Hasan ◽  
ABM Abdus Salam ◽  
Quazi Abul Azad ◽  
Sadia Sajmin Siddiqua ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Pulmonary Valve ◽  
Total Correction ◽  
Early Outcome ◽  
Transannular Patch ◽  
Group A ◽  
Valve Annulus ◽  
Z Value ◽  
Group B

Background: It is arguable whether presence of transannular patch is itself a risk factor for adverse outcome at total correction(repair) of tetralogy of Fallot (TOF).This study intended to compare early outcome of intact pulmonary valve annulus with transannular patching at repair of TOF.Methods: This prospective observational study was conducted from July 2015 to January 2017.40 patients were enrolled in 2 groups- A & B.In group A,14 patients with intact pulmonary valve annulus& in group B, 26 patients with transannular patch. The diameter of pulmonary valve annulus was measured with Hegar dilator and Z value of the measured diameter were calculated from an established published nomogram. Transannular patch was placed if Z value of annular diameter < -3 or post repair operative room right ventricle/left ventricle pressure ratio (P RV/LV)> 0.7.Patients were monitored in the intensive care unit(ICU) and followed up for 3 months following discharge from hospital.Results: Patients of group B were younger and smaller body surface area. There were no significant difference of preoperative variables in terms of peripheral arterial oxygen saturation(SpO2%), haematocrit (%),NYHA functional class, right ventricular hypertrophy, and level & severity of right ventricular out flow tract obstruction. Early out come in terms of duration of ventilation time, inotrope support & ICU stay; post operative morbidity & mortality were more in group B than group A patients. Pulmonary regurgitation & right ventricular dysfunction following transannular patch at repair of TOF plays important role for adverse outcome.Conclusion: Transannular patch is associated with higher morbidity and mortality in total correction of Tetralogy of Fallot.Cardiovasc. j. 2018; 10(2): 194-200

scholarly journals Long-term outcomes after definitive repair for tetralogy of Fallot with preservation of the pulmonary valve annulus

2014 ◽  
Vol 148 (3) ◽  
pp. 802-809 ◽  
Author(s):  
Takaya Hoashi ◽  
Koji Kagisaki ◽  
Yin Meng ◽  
Heima Sakaguchi ◽  
Kenichi Kurosaki ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Pulmonary Valve ◽  
Long Term Outcomes ◽  
Definitive Repair ◽  
Valve Annulus

scholarly journals Systemic-Pulmonary Shunt Facilitates the Growth of the Pulmonary Valve Annulus in Patients With Tetralogy of Fallot

2016 ◽  
Vol 102 (4) ◽  
pp. 1322-1328 ◽  
Author(s):  
Byung Kwon Chong ◽  
Jae Suk Baek ◽  
Yu-Mi Im ◽  
Chun Soo Park ◽  
Jeong-Jun Park ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Pulmonary Valve ◽  
Pulmonary Shunt ◽  
Valve Annulus

scholarly journals Fetal Cardiac Parameters for Predicting Postnatal Operation Type of Fetuses With Tetralogy of Fallot

2021 ◽  
Author(s):  
Suyeon Park ◽  
Hye-Sung Won ◽  
Rina Kim ◽  
Mijin Kim ◽  
Jeong Jin Yu ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Pulmonary Valve ◽  
Medical Center ◽  
Peak Systolic Velocity ◽  
Shunt Operation ◽  
Z Score ◽  
Corrective Surgery ◽  
Surgery Group ◽  
Right Pulmonary Artery ◽  
Valve Annulus

Abstract Background: To assess fetal cardiac parameters predictive of postnatal operation type in fetuses with tetralogy of Fallot (TOF). Methods: Echocardiographic data obtained in the second and third trimesters were retrospectively reviewed for fetuses diagnosed with TOF between 2014 and 2018 at Asan Medical Center. The following fetal cardiac parameters were analyzed: 1) pulmonary valve annulus (PVA) z-score, 2) right pulmonary artery (RPA) z-score, 3) aortic valve annulus (AVA) z-score, 4) pulmonary valve peak systolic velocity (PV-PSV), 5) PVA/AVA ratio, and 6) RPA/descending aorta (DAo) ratio. These cardiac parameters were compared between a primary corrective surgery group and a palliative shunt operation followed by complete repair group. Results: A total of 100 fetuses with TOF were included. Only one neonatal death occurred. Ninety patients underwent primary corrective surgery and 10 neonates underwent a multistage surgery. The PVA z-score, RPA z-score, and RPA/DAo ratio measured in the second trimester and the PVA z-score, RPA z-score, and PVA/AVA raio measured in the third trimester were significantly lower in the multistage surgery group, while the PV-PSV as measured in both trimesters were significantly higher in the multistage surgery group. Conclusion: Fetal cardiac parameters are useful for predicting the operation type necessary for neonates with TOF.

Optimal Use of Z-Scores to Preserve the Pulmonary Valve Annulus During Repair of Tetralogy of Fallot

2018 ◽  
Vol 9 (3) ◽  
pp. 285-288 ◽  
Author(s):  
Mark Nelson Awori ◽  
Nikita P. Mehta ◽  
Frederick O. Mitema ◽  
Naomi Kebba
Keyword(s):  
Pulmonary Valve ◽  
Operative Procedure ◽  
Data Sets ◽  
Z Score ◽  
Data Set ◽  
Death Studies ◽  
Transannular Patch ◽  
Z Scores ◽  
Different Populations ◽  
Valve Annulus

Objective: The size of the pulmonary annulus measured as a z-score is often used to determine when to insert a transannular patch (TAP). Multiple “cutoffs” are quoted in the literature; this could lead to inappropriate insertion. We aimed to determine whether the use of z-scores derived from different populations may have contributed to the varied “cutoffs” quoted. Methods: PubMed was searched using the terms: “tetralogy,” “Fallot,” “transannular,” “patch,” “mortality,” and “death.” Studies published between January 1, 2005, and October 5, 2017, were included; studies without participants under the age of 18 years and studies that did not describe the operative procedure were excluded. Results: Of 52 papers retrieved, 19 were included representing 2,500 repaired patients; 1,371 (54.8%) had a TAP. Five (26.3%) papers representing 638 patients (25.5%) quoted a z-score “cutoff” and what data set was used; “cutoffs” ranged from −2 to −4 and were derived from 2 different data sets. Three studies quoted a data set that has been shown in previous work to be problematic; the only quoted “cutoffs” of −4 were from two of these studies. Conclusions: Surprisingly few (26.3%) studies mention what pulmonary annulus size “cutoff” was used to decide when to insert a TAP. Z-scores derived from different populations were used by different studies and it is possible that this may have contributed to the varied “cutoffs’ quoted. Recommendations to perform valve-sparing surgery in pulmonary annuli as small as −4 may not be warranted. Future papers should record “cutoffs” employing recommended z-score data set.

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