scholarly journals Predictors of Transannular Patch Enlargement in Tetralogy of Fallot Repair; a Single Center Experience

2021 ◽  
pp. 1-10
Author(s):  
Petronila N. Tabansi ◽  
Sanjukta Bose Barghava ◽  
Atul Prabhu ◽  
Uchenna Onubogu ◽  
Prashant Takhur ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Tetralogy Of Fallot ◽  
Pulmonary Valve ◽  
Heart Diseases ◽  
Univariate Analysis ◽  
Surgical Techniques ◽  
Categorical Variables ◽  
Z Score ◽  
Transannular Patch ◽  
Aortic Valve Diameter

Introduction: Tetralogy of Fallot (ToF) accounts for 5% to 10% of all congenital heart diseases (CHD) and is the commonest cyanotic heart disease beyond the neonatal period. Surgical repair is directed at relieving the right ventricular outflow tract obstruction (RVOTO) and has evolved over time from the frequent use of transannular patch enlargement (TAPE) of the pulmonary valve annulus (PVA), to the more recent trend of conservation of the PVA using valve-sparing surgical techniques. This is latter technique is preferred to avoid serious and progressive complications associated with TAPE. The decision on TAPE is primarily base on the PVA z-score which is subject to variability across different surgeons and centers; as such, other parameters have been proposed and some determined to be better predictors of TAPE in ToF surgeries. Aim: To determine the predictors of transannular patch enlargement in ToF surgeries in a CHD specialist center.  Methods: This was a retrospective analysis of all patient with ToF who presented at a major CHD center - the Sri Sathya Sai Sanjeevani Hospital (SSSSH), in Raipur India between July 2018 to April 2019. Parameters sought and obtained included patients’ demographics, anthropometry and echocardiographic parameters. The z-scores and other derivable variables were calculated and entered into a data base. Analysis using SPSS was done. Descriptive statistics was used to represent continuous variables in means, medians and ranges while categorical variables were represented in bar chats. Analysis of variance was done among group means. Results: There were 135 patients with age range from 7months to 199 months, with more males 89 (65.9%). TAPE was done in 36(26.7%). The aortic valve diameter (18.3 Vs 20mm, p=0.037), Pulmonary valve diameter (10.1 vs 12.0mm, P=0.003), and pulmonary valve Z-score (-2.48 vs -1.47, p=0.011) were significantly smaller for the group that received TAPE. Univariate analysis of the great artery ratio (PVA/AoV) did not significantly predict TAPE use. However, a GA ratio of < 0.54 was significantly associated with a higher likelihood of having TAPE, odds ratio 2.37(CI: 1.47 to 3.9). Multivariate logistic for use of TAPE in TOF explained 15% (R2) of the variance seen in the use of TAPE and correctly predicted 70.8% of the children with TOF who received TAPE. The area under curve for predictability of who received TAPE was 65% (95% CI 53.5% to 76.6. Conclusion: The PVA diameter, Aortic valve diameter and PVA z-score are predictors of TAPE. A GA ratio < 0.54 increases the likelihood of TAPE. Clinical parameters are not useful as determinants of TAPE.

scholarly journals Echocardiographic comparison between pulmonary valve preservation and transannular patch techniques in children with repaired Tetralogy of Fallot

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
M Avesani ◽  
A Guariento ◽  
CA Schiena ◽  
E Reffo ◽  
B Castaldi ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Ventricular Function ◽  
Tetralogy Of Fallot ◽  
Right Ventricular Function ◽  
Speckle Tracking ◽  
Pulmonary Valve ◽  
Pulmonary Regurgitation ◽  
Z Score ◽  
Transannular Patch

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Many centers have recently adopted pulmonary valve (PV) preservation procedures to prevent the detrimental long-term effects of chronic pulmonary regurgitation after tetralogy of Fallot (ToF) repair. PURPOSE The aim of our study was to investigate pulmonary valve (PV) and right ventricular function by echocardiography in paediatric patients with repaired Tetralogy of Fallot (ToF), comparing PV preservation surgical strategies to standard transannular patch (TAP) repair. METHODS All patients undergoing transatrial-transpulmonary repair for ToF at our institution between January 2007 and May 2020 were reviewed retrospectively. Patients were divided into 2 main groups, according to the different techniques used: patients undergoing a PV preservation strategy and patients undergoing TAP repair. All patients underwent standard echo-Doppler study including RV end-diastolic area (RVEDA), end-systolic area (RVESA), fractional area change (FAC) and TAPSE; PR was assessed by Color Doppler, continuous-wave (CW) Doppler and derived parameters such as pressure half time (PHT) and pulmonary regurgitation (PR) index. By speckle tracking we measured also, in a subgroup of patients, right atrial strain (RAS), RV and left ventricle (LV) global longitudinal strain (RVGLS, LVGLS) and their time to peak (TTP) values. RESULTS Overall, 82 patients underwent a successful PV preservation strategy while 34 underwent a standard TAP repair. At index surgery, BSA (0.31 ± 0.1 m2, P = 0.3), age (4.8 ± 0.3 months, P = 0.5) and preoperative PV Z-score (-3.20 ± 0.1, P = 0.1) did not different between groups. Five-year actuarial freedom from moderate/severe PV regurgitation was significantly higher in the PV preservation group compared to the TAP (61.3% [95% CI: 48-73%] vs 25.9% [95% CI: 12-43%], respectively; p = 0.02). After adjusting for age, gender, BSA, and type of PV, the use of a TAP was still significantly associated with an increased risk for PV regurgitation at follow up (HR: 1.85, 95% CI: 1.09, 3.15; p = 0.02). At a mean follow-up of 6.9 ± 0.3 years, patients undergoing PV preservation showed an increased right ventricular fractional area change (46.9 ± 0.8% vs 42.5 ± 1.7%, P &lt; 0.001) and tricuspid annular plane systolic excursion (TAPSE) z-score (-3.36 ± 0.3% vs -4.7 ± 0.4%, P = 0.005), while maintaining better PV competence in terms of pulmonary regurgitation index (87.9 ± 1.2% vs 82.7 ± 2.4%, P = 0.02). At speckle tracking subanalysis, patients undergoing PV preservation (n= 23), compared to the TAP group (n = 13) showed also higher values of RAS (37.5 ± 6.0% vs 29.3 ± 8.2% ,  P &lt; 0.006), shorter right TTP (319 ± 39ms vs 357.5 ± 45.2 ms, P &lt; 0.01) and higher values of LVGLS (-20,6 ± 4,2% vs -17.5 ± 3.0, P &lt; 0.03). CONCLUSIONS Surgical repair of ToF with PV preservation provides excellent outcomes in terms of PV competence and right ventricular function and should be advocated whenever possible. Abstract Figure. Degree of pulmonary regurgitation

scholarly journals Pulmonary valve restitution following transannular patch repair of tetralogy of Fallot†

2017 ◽  
Vol 25 (6) ◽  
pp. 985-986 ◽  
Author(s):  
Khushboo N Parikh ◽  
Nishant C Shah ◽  
Joseph B Clark ◽  
John L Myers
Keyword(s):  
Tetralogy Of Fallot ◽  
Pulmonary Valve ◽  
Patch Repair ◽  
Transannular Patch

scholarly journals Fresh Autologous Pericardium to Reconstruct the Pulmonary Valve at the Annulus When Tetralogy of Fallot Requires a Transannular Patch at Midterm

2016 ◽  
Vol 43 (3) ◽  
pp. 207-213 ◽  
Author(s):  
Shantanu Pande ◽  
Jugal K. Sharma ◽  
C.R. Siddartha ◽  
Anubhav Bansal ◽  
Surendra K. Agarwal ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Pulmonary Valve ◽  
Right Ventricular Outflow Tract ◽  
Right Ventricular Dysfunction ◽  
Pulmonary Insufficiency ◽  
Autologous Pericardium ◽  
Transannular Patch ◽  
Significant Difference

Tetralogy of Fallot often requires reconstruction of the right ventricular outflow tract with a transannular patch (TAP), but this renders the pulmonary valve incompetent and eventually leads to right ventricular dysfunction. We retrospectively evaluated the efficacy of a reconstructed pulmonary valve and annulus in 70 patients who underwent, from December 2006 through December 2010, complete correction of tetralogy of Fallot. We divided the 70 patients into 2 groups in accordance with whether they required (n=50) or did not require (n=20) a TAP. We used autologous untreated pericardium to fashion the TAP and to create both an annulus of the correct size and a competent pulmonary valve with native leaflets. We evaluated the efficiency of this procedure both functionally and anatomically. The median age of the patients was 11 years (range, 2–38 yr). There were 56 males, with no significant difference in sexual distribution between groups. The clinical follow-up was 88% for 57.5 months, and the echocardiographic follow-up was 80% for 36 months. There was no significant difference in outflow gradient or in the occurrence of pulmonary insufficiency between the TAP group (none, 31; mild, 12; moderate, 6; and severe, 1) and the No-TAP group (none, 16; moderate, 2; and severe, 2) (P=0.59). Nor was there any thickening or calcification in the constructed valves. We conclude that pulmonary valves constructed of untreated autologous pericardium performed as well as native valves after total tetralogy of Fallot correction at midterm.

scholarly journals Tetralogy of Fallot with Absent Pulmonary Valve - A Case Report

1970 ◽  
Vol 6 (1) ◽  
pp. 48-50
Author(s):  
Md Mazibur Rahman
Keyword(s):  
Heart Failure ◽  
Tetralogy Of Fallot ◽  
Septal Defect ◽  
Pulmonary Valve ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Absent Pulmonary Valve ◽  
Transannular Patch ◽  
Patch Closure ◽  
Successful Repair

A 25 years male patient of Tetralogy of Fallot (TOF) with congenital absent of pulmonary valve (APV) presented with symptoms of palpitation and exertional respiratory distress without congestive heart failure. He underwent successful repair of intracardiac defects. The procedures consisted of patch closure of ventricular septal defect and right. ventricular outflow tract reconstruction with a monocusp transannular patch. Resection or plication of dilated pulmonary artery was not required. The patient is doing well without any symptoms. Key words: Tetralogy of Fallot; Absent pulmonary valve DOI: 10.3329/uhj.v6i1.7197University Heart Journal Vol.6(1) 2010 pp.48-50

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 Early versus late pulmonary valve replacement in patients with transannular patch-repaired tetralogy of Fallot

2017 ◽  
Vol 25 (3) ◽  
pp. 427-433 ◽  
Author(s):  
Bieke Dobbels ◽  
Marie-Christine Herregods ◽  
Els Troost ◽  
Alexander Van De Bruaene ◽  
Filip Rega ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Valve Replacement ◽  
Transannular Patch ◽  
Repaired Tetralogy Of Fallot
Sign in / Sign up

Export Citation Format

Share Document