Residual Problems With Repaired Tetralogy of Fallot

Mizuno, Atsushi; Niwa, Koichiro

doi:10.1253/circj.cj-14-0479

Cited by 3 publications

(1 citation statement)

References 17 publications

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“…PR is the most common and important clinical complication that usually occurs approximately 10 years after TOF repair. PR causes right ventricle enlargement and other complications, such as left ventricular insufficiency, arrhythmias, heart failure, and death [Mizuno 2014]. Currently, pulmonary valve replacement, percutaneous pulmonary valve stent implantation, percutaneous aortopulmonary stent implantation, and other surgical methods achieve good results; however, they have some drawbacks.…”

Section: Introductionmentioning

confidence: 99%

Embolization of Aortopulmonary Collateral Artery Cooperate with Valved Conduit Attached to the Right Ventricular Outflow Tract for Patient After Tetralogy of Fallot Repair: A One-Stop Procedure

Wu¹,

Chen²,

Li³

et al. 2022

HSF

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We describe a one-stop procedure for aortopulmonary collateral artery (APCA) and postoperative complications of Tetralogy of Fallot (TOF). Postoperative complications of TOF include right ventricular outflow tract stenosis, pulmonary valvular annular stenosis, pulmonary regurgitation, and aortopulmonary artery stenosis. The one-stop procedure was defined as after APCA embolization. The heart continued to function under cardiopulmonary bypass during median sternotomy to reconstruct the right ventricular outflow tract with a valved conduit and replace the aortopulmonary artery. A biological valved was sewed within the valved conduit in an artificial blood vessel in vitro and subsequently was used in the procedure and achieved significant results.

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Section: Introductionmentioning

confidence: 99%

Embolization of Aortopulmonary Collateral Artery Cooperate with Valved Conduit Attached to the Right Ventricular Outflow Tract for Patient After Tetralogy of Fallot Repair: A One-Stop Procedure

Wu¹,

Chen²,

Li³

et al. 2022

HSF

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Pulmonary Valve Replacement With Fresh Decellularized Pulmonary Allograft for Pulmonary Regurgitation After Tetralogy of Fallot Repair　– First Case Report in Japan –

Ueno

Ozawa

Terabe

et al. 2016

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp fraction of 50.8%, a significantly enlarged RV (RV end-diastolic volume index of 160 ml/m 2 ) with depressed contractility, and RV ejection fraction of 30%. Accordingly, we decided to perform PVR with a recommendation of a fresh decellularized pulmonary allograft for the following reasons: (1) the relatively young age of the patient meant he might otherwise require multiple PVR in his lifetime if he received a commercially available biological valve; (2) long term anticoagulation therapy after PVR was not required; and (3) absence of pulmonary hypertension. He agreed to our recommendation, and we received approval from the Ethical Committee at Osaka University to use this approach.The fresh pulmonary allograft was provided by the German Society for Tissue Transplantation (Hannover, Germany) and decellularized by CorLife GbH (Hannover, Germany) (Figure 1). This decellularized human pulmonary valve (ESPOIR pulmonary valve) has been approved in Germany (approval no.: PEI.G.11634.01.1) for heart valve replacement since 2013, and ESPOIR pulmonary valves are currently being used in an investigative trial (NCT 02035540, ClinicalTrials. gov) in Europe. The operation was performed using re-median sternotomy, aortic and bicaval cannulation, and normothermic ulmonary valve regurgitation (PR) is the most common clinically important complication, typically occurring about 10 years after tetralogy of Fallot (TOF) repair. PR causes right ventricular (RV) enlargement as well as other complications, such as left ventricular dysfunction, arrhythmias, heart failure, and death. 1-3 Pulmonary valve replacement (PVR) is recommended before the occurrence of RV dysfunction, but the timing is still controversial because biological valves and cryopreserved homografts have relatively short durability with some late disadvantages, especially in adolescents. 4,5 Herein, we report the first clinical application of a decellularized fresh pulmonary allograft for PVR in Japan.The patient was a 35-year-old man diagnosed with TOF at birth. He underwent TOF repair using a mono-cusped transannular patch with mini-right ventriculotomy (Method III) 6 at 2 years of age in Osaka University Hospital. The postoperative course was uneventful for a few decades, but PR gradually progressed, and RV enlargement was recognizable. The ECG showed normal sinus rhythm, with QRS duration of 160 ms. Echocardiography showed RV enlargement, moderate to severe PR, and trivial tricuspid valve regurgitation. Cardiac magnetic resonance imaging showed a pulmonary valve regurgitant Methods and Results:A fresh decellularized pulmonary allograft was used for PVR to correct pulmonary valve regurgitation in a 35-year-old man 33 years following tetralogy of Fallot repair. The postoperative course and shortterm valve function were excellent. This is the first case of a decellularized pulmonary allograft in Japan. therefore, there is a strong need for new-concept valves with markedly...

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Application of a Fresh Decellularized Pulmonary Allograft for Pulmonary Valve Replacement in Japan

Ozawa

Ueno

Terabe

et al. 2018

Circ J

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Background: Tissue engineering has advanced the technique of decellularization of the heart valve. The valve is reseeded with the patient's own cells after implantation with suppression of immunologic reactions. The same advantage has been reported for fresh decellularized heart valves, and more than 10 years of excellent outcomes have been achieved. We began performing such heart valve implantations in 2013 as part of a clinical study at Osaka University. We report our evaluation of the safety and efficacy of heart valve implantation. Methods and Results:Human pulmonary valves from the German Society for Tissue Transplantation (n=2) or from Japanese heart transplant recipient heart (n=4) were used to make decellularized heart valves; the decellularization process was the same as that used in Europe. Valves were implanted in 5 adults with pulmonary valve insufficiency after tetralogy of Fallot repair and in 1 infant with a double-outlet right ventricle with pulmonary stenosis. Postoperative echocardiography and cardiac magnetic resonance imaging revealed that the valve and ventricular function were significantly improved and maintained postoperatively. Conclusions:Decellularized heart valves could be the new material used as artificial heart valves. Pulmonary allografts derived from the hearts of heart transplant recipients are considered to be useful material for decellularized heart valves. The application of this valve to Japanese clinical circumstances and using the hearts of heart transplant recipients is considered to be very significant.

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Residual Problems With Repaired Tetralogy of Fallot

Cited by 3 publications

References 17 publications

Embolization of Aortopulmonary Collateral Artery Cooperate with Valved Conduit Attached to the Right Ventricular Outflow Tract for Patient After Tetralogy of Fallot Repair: A One-Stop Procedure

Embolization of Aortopulmonary Collateral Artery Cooperate with Valved Conduit Attached to the Right Ventricular Outflow Tract for Patient After Tetralogy of Fallot Repair: A One-Stop Procedure

Pulmonary Valve Replacement With Fresh Decellularized Pulmonary Allograft for Pulmonary Regurgitation After Tetralogy of Fallot Repair　– First Case Report in Japan –

Application of a Fresh Decellularized Pulmonary Allograft for Pulmonary Valve Replacement in Japan

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Residual Problems With Repaired Tetralogy of Fallot

Cited by 3 publications

References 17 publications

Embolization of Aortopulmonary Collateral Artery Cooperate with Valved Conduit Attached to the Right Ventricular Outflow Tract for Patient After Tetralogy of Fallot Repair: A One-Stop Procedure

Embolization of Aortopulmonary Collateral Artery Cooperate with Valved Conduit Attached to the Right Ventricular Outflow Tract for Patient After Tetralogy of Fallot Repair: A One-Stop Procedure

Pulmonary Valve Replacement With Fresh Decellularized Pulmonary Allograft for Pulmonary Regurgitation After Tetralogy of Fallot Repair – First Case Report in Japan –

Application of a Fresh Decellularized Pulmonary Allograft for Pulmonary Valve Replacement in Japan

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Pulmonary Valve Replacement With Fresh Decellularized Pulmonary Allograft for Pulmonary Regurgitation After Tetralogy of Fallot Repair　– First Case Report in Japan –