Does limited right ventriculotomy prevent right ventricular dilatation and dysfunction in patients who undergo transannular repair of tetralogy of Fallot? Matched comparison of magnetic resonance imaging parameters with conventional right ventriculotomy long-term after repair

Abstract

No long-term benefits of limited RV-tomy were demonstrated compared with conventional RV-tomy in patients who underwent transannular TOF repair, at least in terms of RV volume and function. Further studies are necessary to define the role of limited RV-tomy in patients who undergo transannular TOF repair.

Factors associated with right ventricular dilatation and dysfunction in patients with chronic pulmonary regurgitation after repair of tetralogy of Fallot: Analysis of magnetic resonance imaging data from 218 patients

“…We found that VSD closure through the right ventricle (transventricular approach) was an independent predictor for RV dilatation and dysfunction. Controversy regarding the optimal surgical technique (eg, transatrial vs transventricular approach) for TOF still exists, 19 and this has resulted from a lack of long-term follow-up data confirming the superiority of any 1 approach. Lindberg and colleagues, 2 in their long-term follow-up study, found no differences between transatrial and transventricular repair on survival or repeat repair.…”

Long-term outcomes following transatrial versus transventricular repair on right ventricular function in tetralogy of Fallot

“…More recently, van den Berg et al showed that 59 TA patients (71% TAP) had progressive RV dilatation and ventricular dysfunction during follow‐up. Lee et al reported that PR fraction was an independent predictor of RV dilatation and dysfunction. These studies suggest that utilization of TAP during surgical correction play a significant role in postoperative TOF pathophysiology.…”

“…Cardiac magnetic resonance is now the gold standard modality for assessment of late RV volumes and function . Lee et al directly compared long‐term outcomes after TA or TV repair with CMR imaging, and showed no differences in chamber dimensions, PR severity, and freedom from PV replacement. They speculated that after TA repair of TOF, both utilization of a TAP and extensive RVOT muscle bundle resection might contribute significantly to late RV dilatation and dysfunction.…”

One-Year Follow-up After Tetralogy of Fallot Total Repair Preserving Pulmonary Valve and Avoiding Right Ventriculotomy

“…1,2,4,5,11 Because of the aforementioned problems, many surgeons have tried to preserve the pulmonary valvular function and minimize the RV incision by various surgical modifications. [6][7][8][9][10]12,13,16,17 Some surgeons make a separate external incision in the infundibular area (RV-tomy) to remove more hypertrophied infundibular muscles through the RVtomy site while preserving the pulmonary valve annulus. 9,10 In the case of small pulmonary valve annulus and z-score <−3, however, preservation of the pulmonary valve annulus still seems to be difficult with sufficient relief of PS.…”