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Ann Thorac Surg 1988;45:610-613
© 1988 The Society of Thoracic Surgeons

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Articles

Pulmonary Valve Insertion during Reoperation for Tetralogy of Fallot

Section of Thoracic and Cardiovascular Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN and Mayo Clinic Jacksonville, Jacksonville, FL

Accepted for publication December 28, 1987.

^* Address reprint requests to Dr. Puga, Mayo Clinic, 200 First St SW, Rochester, MN 55905

Our experience with pulmonary valve insertion during reoperation for residual lesions after initial open repair of tetralogy of Fallot in 15 patients is reported. Preoperatively, 14 patients were in moderate to severe congestive heart failure, and all 15 had decreased right ventricular (RV) function at cardiac catheterization. All 15 patients had pulmonary insufficiency but not as an isolated finding. The most common residual lesions encountered were ventricular septal defect in 9, tricuspid insufficiency in 11, and peripheral pulmonary arterial stenosis in 6. Tissue valves were inserted in all patients. Mean peak RV-left ventricular pressure ratio measured in the operating room decreased from 0.61 ± 0.10 (± the standard deviation) to 0.47 ± 0.17 (p < 0.05). There were no operative deaths. At follow-up (mean, 33 months), all but 1 patient were in New York Heart Association Class I or II. Pulmonary valve insertion should be considered during reoperation for tetralogy of Fallot when pulmonary insufficiency and RV failure are present.

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