| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2003;76:1066-1071
© 2003 The Society of Thoracic Surgeons
a Divisions of Cardiothoracic Surgery, Tufts-New England Medical Center and Boston Floating Hospital, Tufts University School of Medicine, Boston, Massachusetts, USA
b division of Pediatric Cardiology, Tufts-New England Medical Center and Boston Floating Hospital, Tufts University School of Medicine, Boston, Massachusetts, USA
Accepted for publication April 17, 2003.
* Address reprint requests to Dr Warner, Division of Cardiothoracic Surgery, New England Medical Center, Box 266, 750 Washington St, Boston, MA 02111, USA
e-mail: kwarner{at}tufts-nemc.org
BACKGROUND: Insertion of a competent pulmonary valve has been advocated to reduce right ventricular volume overload associated with pulmonary regurgitation (PR) after repair of tetralogy of Fallot. However the indications, proper timing, and long-term benefits of restoring pulmonary valve function remain controversial.
METHODS: Thirty-six patients (aged 15.2 ± 9.2 years) underwent pulmonary valve implantation (31 homografts, 5 heterografts) 12.2 ± 6.9 years after tetralogy repair. Additional surgical procedures included pulmonary artery augmentation (n = 14), closure of septal defects (n = 10), and cryoablation and endocardial resection of ventricular tachycardia (n = 2).
RESULTS: All patients have had clinical improvement in their exercise capacity. Preoperative and postoperative bicycle ergometry tests in 6 patients demonstrated significant improvement in the percent of predicted peak workload (68.5% ± 19.8% to 80.7% ± 17.4%, p < 0.015). One midterm death occurred in a 38-year-old patient with a history of ventricular tachycardia who died suddenly 2 years after pulmonary valve insertion. Postoperative echocardiographic measurements were available in 34 patients at a mean follow-up of 5 years. There was a 30% reduction in right ventricular end-diastolic diameter indexed to body surface area after surgery (30.1 ± 10.2 to 18.6 ± 6.0 mm/m2, p < 0.0001). Two patients required conduit replacements at 1 and 9 years postoperatively.
CONCLUSIONS: Timely insertion of a competent pulmonary valve in children, adolescents, and young adults with significant PR after tetralogy of Fallot repair results in subjective and objective improvement in exercise capacity and is associated with reduction in right ventricle size.
This article has been cited by other articles:
|
|
 |
|
  A. Frigiola, V. Tsang, C. Bull, L. Coats, S. Khambadkone, G. Derrick, B. Mist, F. Walker, C. van Doorn, P. Bonhoeffer, et al. Biventricular Response After Pulmonary Valve Replacement for Right Ventricular Outflow Tract Dysfunction: Is Age a Predictor of Outcome? Circulation, September 30, 2008; 118(14_suppl_1): S182 - S190. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. C. Fiore, M. Rodefeld, M. Turrentine, P. Vijay, T. Reynolds, J. Standeven, K. Hill, J. Bost, D. Carpenter, C. Tobin, et al. Pulmonary valve replacement: a comparison of three biological valves. Ann. Thorac. Surg., May 1, 2008; 85(5): 1712 - 1718. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Nordmeyer, L. Coats, P. Lurz, T.-Y. Lee, G. Derrick, P. Rees, S. Cullen, A. M. Taylor, S. Khambadkone, and P. Bonhoeffer Percutaneous pulmonary valve-in-valve implantation: a successful treatment concept for early device failure Eur. Heart J., March 3, 2008; (2008) ehn073v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A L Knauth, K Gauvreau, A J Powell, M J Landzberg, E P Walsh, J E Lock, P J d. Nido, and T Geva Ventricular size and function assessed by cardiac MRI predict major adverse clinical outcomes late after tetralogy of Fallot repair Heart, February 1, 2008; 94(2): 211 - 216. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. J. Meijboom, J. W. Roos-Hesselink, J. S. McGhie, S. E.C. Spitaels, R. T. van Domburg, L. M.W.J. Utens, M. L. Simoons, and A. J.J.C. Bogers Consequences of a selective approach toward pulmonary valve replacement in adult patients with tetralogy of Fallot and pulmonary regurgitation J. Thorac. Cardiovasc. Surg., January 1, 2008; 135(1): 50 - 55. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Gengsakul, L. Harris, T. J. Bradley, G. D. Webb, W. G. Williams, S. C. Siu, N. Merchant, and B. W. McCrindle The impact of pulmonary valve replacement after tetralogy of Fallot repair: a matched comparison Eur. J. Cardiothorac. Surg., September 1, 2007; 32(3): 462 - 468. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Ghez, V. T. Tsang, A. Frigiola, L. Coats, A. Taylor, C. Van Doorn, P. Bonhoeffer, and M. De Leval Right ventricular outflow tract reconstruction for pulmonary regurgitation after repair of tetralogy of Fallot.: Preliminary results Eur. J. Cardiothorac. Surg., April 1, 2007; 31(4): 654 - 658. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Dodge-Khatami, E. V. Buchel, W. Knirsch, A. Kadner, V. Rousson, H. H. Dave, U. Bauersfeld, and R. Pretre Brain natriuretic peptide and magnetic resonance imaging in tetralogy with right ventricular dilatation. Ann. Thorac. Surg., September 1, 2006; 82(3): 983 - 988. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. R. V. Buechel, H. H. Dave, C. J. Kellenberger, A. Dodge-Khatami, R. Pretre, F. Berger, and U. Bauersfeld Remodelling of the right ventricle after early pulmonary valve replacement in children with repaired tetralogy of Fallot: assessment by cardiovascular magnetic resonance Eur. Heart J., December 2, 2005; 26(24): 2721 - 2727. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. E. van der Wall and B. J.M. Mulder Pulmonary valve replacement in patients with tetralogy of Fallot and pulmonary regurgitation: early surgery similar to optimal timing of surgery? Eur. Heart J., December 2, 2005; 26(24): 2614 - 2615. [Full Text] [PDF]
|
|
|
|
|
|
S. Khambadkone, L. Coats, A. Taylor, Y. Boudjemline, G. Derrick, V. Tsang, J. Cooper, V. Muthurangu, S. R. Hegde, R. S. Razavi, et al. Percutaneous Pulmonary Valve Implantation in Humans: Results in 59 Consecutive Patients Circulation, August 23, 2005; 112(8): 1189 - 1197. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. A. Warnes The Adult With Congenital Heart Disease: Born To Be Bad? J. Am. Coll. Cardiol., July 5, 2005; 46(1): 1 - 8. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Quintessenza, J. P. Jacobs, V. O. Morell, J. M. Giroud, and R. J. Boucek Initial Experience With a Bicuspid Polytetrafluoroethylene Pulmonary Valve in 41 Children and Adults: A New Option For Right Ventricular Outflow Tract Reconstruction Ann. Thorac. Surg., March 1, 2005; 79(3): 924 - 931. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. P. Graham Jr The year in congenital heart disease J. Am. Coll. Cardiol., June 2, 2004; 43(11): 2132 - 2141. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
