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Ann Thorac Surg 2009;87:1879-1884. doi:10.1016/j.athoracsur.2009.02.068
© 2009 The Society of Thoracic Surgeons
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Andreas Zierer
Farhad Bakhtiary
Feyzan Özaslan
Anton Moritz
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Original Articles: Pediatric Cardiac

Secondary Repair of Incompetent Pulmonary Valves

Nestoras Papadopoulos, MDa,*, Anoosh Esmaeili, MDb, Andreas Zierer, MDa, Farhad Bakhtiary, MD, PhDa, Feyzan Özaslan, MDa, Anton Moritz, MD, PhDa

a Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Germany
b Department of Pediatric Cardiology, Johann Wolfgang Goethe University, Frankfurt, Germany

Accepted for publication February 24, 2009.

* Address correspondence to Dr Papadopoulos, Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Theodor Stern Kai 7, Frankfurt am Main, 60590, Germany (Email: nestoras.papadopoulos{at}gmail.com).

Background: Secondary repair of the pulmonary valve after right ventricular outflow tract (RVOT) reconstruction is infrequently reported. This article describes possible techniques of secondary pulmonary valve repair and reports follow-up results.

Methods: Secondary pulmonary valve repairs in 7 patients (5 children and 2 adults) in our institution were reviewed. All patients presented with a severe pulmonary valve regurgitation associated with RV dilatation and dysfunction after primary RVOT reconstruction.

Results: The surgical techniques varied in our series, but secondary repair of the incompetent pulmonary valve was possible in all patients. Follow-up was complete, with a mean follow-up of 4.1 ± 2.7 years. There were no operative or late deaths in our group. All valves were repaired successfully, with a mean regurgitation grade of 1.28 ± 0.5 postoperatively. The mean transvalvular gradient was 20 ± 4.1 mm Hg for children and 22.5 ± 3.5 mm Hg for adults, and no significant increase of pulmonary valve regurgitation occurred during follow-up. The mean RV dilatation index (RVDI) decreased significantly from 0.85 ± 0.25 to 0.6 ± 0.2 for children and from 1.4 ± 0.01 to 0.9 ± 0.05 for adults.

Conclusions: Our results showed functional recovery of the right ventricle after reoperation, with RVDI recovering to almost normal values in children. No significant regurgitation of the secondarily reconstructed pulmonary valve was observed during the 4-year follow-up period. Secondary repair for pulmonary valve incompetence after RVOT procedures might be a valuable alternative to conduit replacement.


Related Article

Invited Commentary
Glenn J. Pelletier
Ann. Thorac. Surg. 2009 87: 1884. [Extract] [Full Text] [PDF]



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G. J. Pelletier
Invited Commentary.
Ann. Thorac. Surg., June 1, 2009; 87(6): 1884 - 1884.
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