| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Department of Cardiothoracic Surgery, Leiden University Medical Center, PO Box 9600, Leiden 2300 RC, the Netherlands
(Email: m.g.hazekamp{at}lumc.nl).
A bicuspid pulmonary valve is sometimes found in association with transposition of the great arteries (TGA). After the arterial switch operation the pulmonary valve will become the new aortic valve; therefore it is important to know the fate of a bicuspid pulmonary valve in the systemic circulation.
Khan and colleagues [1] observed a 7% incidence of bicuspid pulmonary valve in their series of 391 arterial switch operations. For unknown reasons this is higher than the prevalence that is reported in other series (ie, 3.2% in Leiden, 1.2% in Melbourne, and 1.7% in Boston [2–4]).
It is reassuring for the moment that in all these series the majority of bicuspid pulmonary valves remains with good function after the arterial switch procedure. Insufficiency is usually no more than trivial or mild and does not seem to progress [1–5]. However, maximal follow-up durations that are reported are no longer than 11 to 20 years, and it is not unthinkable that the bicuspid pulmonary valve may show loss of function at a later stage.
Nevertheless, the data that are now available justify the use of the arterial switch procedure when a "normal" bicuspid pulmonary valve is present in TGA. Even if an aortic valve replacement would be necessary in adulthood it seems reasonable to do an arterial switch operation.
On the other hand, when a bicuspid pulmonary valve is obstructed due to annular hypoplasia, commissural fusion or dysplasia of the valve leaflets, an arterial switch operation may not always be the best choice. This is more frequently found in TGA with ventricular septal defect, and other forms of left ventricular outflow tract (LVOT) obstruction may be present as well [2]. If LVOT obstruction cannot be relieved completely, and if repair of the obstructed pulmonary valve includes more than a limited commissurotomy, it is probably better to avoid doing an arterial switch operation.
One of the 2 patients in the series of Khan and colleagues [1] who developed severe neoaortic regurgitation had a Taussig-Bing anomaly and previous pulmonary artery banding. This resulted in important dilatation of the new aortic root and valvular regurgitation. As the authors mention, it is important to avoid distortion of the geometry of the new aortic root [1]. In the bicuspid pulmonary valve it may be unavoidable to transfer both coronary buttons into one sinus, especially if commissural malalignment exists between pulmonary and aortic valves [5]. Extra care should then be taken to preserve the geometry of the new aortic root as much as possible to prevent malfunction of a bicuspid valve that by nature is already more susceptible to insufficiency.
 |
References |
|---|
 Top References |
|---|
Related Article
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 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 |
