Document Detail

Expanding the indications for pulmonary valve replacement after repair of tetralogy of fallot.
MedLine Citation:
PMID:  14529986     Owner:  NLM     Status:  MEDLINE    
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/m(2), 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.
Kenneth G Warner; Patrick K H O'Brien; Jonathan Rhodes; Avnit Kaur; Davida A Robinson; Douglas D Payne
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  76     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2003 Oct 
Date Detail:
Created Date:  2003-10-07     Completed Date:  2003-11-20     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1066-71; discussion 1071-2     Citation Subset:  AIM; IM    
Division of Cardiothoracic Surgery, Tufts-New England Medical Center and Boston Floating Hospital, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
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MeSH Terms
Child, Preschool
Exercise Tolerance
Follow-Up Studies
Heart Valve Prosthesis Implantation*
Infant, Newborn
Postoperative Complications
Pulmonary Valve / surgery*
Pulmonary Valve Insufficiency / surgery
Tetralogy of Fallot / surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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