Current Strategy of Repair of Tetralogy of Fallot in Children and Adults: Emphasis on a New Technique to Create a Monocusp‐Patch for Reconstruction of the Right Ventricular Outflow Tract

Abstract

Objectives: In older children (>four years) and adults the strategy of repair of tetralogy of Fallot (TOF) should have a low rate of transannular patch to avoid pulmonary insufficiency (PI), and in addition, we developed a new method of reconstruction of the right ventricular outflow tract (RVOT) to reduce PI. Methods: From 2001 through 2005, 74 patients (50 male, 24 female; mean age of 13.6 ± 0.8 years, ranging from four to 34 years) with TOF (67) or double outlet RV (DORV)‐type‐TOF (seven) underwent complete repair. The resection of RVOT stenosis ± pulmonary valvotomy was principally through RA. A new two‐patch technique to create a folded mono‐cusp valve by using autologous pericardium was applied since August 2004. Results: The repair was through RA in 52 patients and through RA + RVOT/PA in 22 patients (18/4). TAPR was performed in 17 patients (23%, eight non‐valved and nine valved). The aortic cross‐clamp time was 130.1 ± 6.8 min in TAPR group and 85.8 ± 4.6 min in non‐TAPR group (p < 0.0001). The operative mortality was 4.0% (3/74) in all and 2.9% (2/67) in TOF patients (due to low output, uncontrollable bleeding, and repeated bleeding from the pulmonary collateral vessels late) and was similar in TAPR or non‐TAPR. The valved patch‐repaired patients had mild PI and good RV function postoperatively up to eight to 12 months. Conclusions: Repair of TOF in older children/adults should include low rate of TAPR of RVOT. If indicated, the new folded monocusp‐patch technique is recommended. It is an effective and simple way to markedly reduce postoperative PI with no additional cost.

Assessment of untreated fresh autologous pericardium as material for construction of heart valve: Result at 5 years

“…[20] Hence, there arises a need to address this factor at the index operation. [21] PR in monocusp method may also be affected by the fact that a competent semilunar valve will require an annulus adequate sinus and sinotubular junction apart from freely mobile and supple leaflets. [22] Since the monocusp method used in this study does not address all these aspect, a perfectly competent valve could not be achieved in all cases.…”

The application of pulmonary valve biorifice for reconstruction of right ventricular outflow tract in tetralogy of Fallot

“…The main concern for this transannular patch is that the integrity of pulmonary valve will be damaged, which results in postoperative pulmonary regurgitation. Thus, the main shortfall of the conventional transannular technique is the poor long-term outcome, and therefore, the chances of reoperation is greater [2]. Long-term pulmonary valve regurgitation can lead to further right ventricular hypertrophy and right heart failure [3].…”

Heart Failure With Preserved Ejection Fraction in Children

“…Therefore, we selected 14 HFpEF patients and 16 SHF patients with matched diuretic doses (32±18 vs. 32±20 mg/m 2 for furosemide, 1.4±2.6 vs. 1.6±3.7 mg/m 2 for thiazide, 42±33 vs. 40±26 mg/m 2 for spironolactone, all P=NS), and compared for TAPVC) were apparently comparable with those generally achieved in surgery for the same types of CHD. 20 We also compared the data from HFpEF patients with TOF, TAPVC or CoA/IAA with those of 21 age-matched non-HFpEF patients following surgery for the same diseases, focusing especially on the serum aldosterone level ( Table 5). HFpEF patients had significantly higher levels of aldosterone than non-HFpEF patients.…”