Document Detail


Expanding the indications for pulmonary valve replacement after repair of tetralogy of fallot.
MedLine Citation:
PMID:  14529986     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Kenneth G Warner; Patrick K H O'Brien; Jonathan Rhodes; Avnit Kaur; Davida A Robinson; Douglas D Payne
Related Documents :
11178676 - Aortic aneurysm rupture in infantile marfan's syndrome.
11515006 - Percutaneous transluminal alcohol septal myocardial ablation after aortic valve replace...
22029996 - Pulmonary hypertension in sickle cell disease.
21819696 - Hemodynamic and histologic characterization of a swine (sus scrofa domestica) model of ...
10768626 - Motor strokes sparing the leg: different lesions and causes.
25112556 - Trial of org 10172 in acute stroke treatment (toast) classification and vascular territ...
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    
Affiliation:
Division of Cardiothoracic Surgery, Tufts-New England Medical Center and Boston Floating Hospital, Tufts University School of Medicine, Boston, Massachusetts 02111, USA. kwarner@tufts-nemc.org
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Child
Child, Preschool
Exercise Tolerance
Female
Follow-Up Studies
Heart Valve Prosthesis Implantation*
Humans
Infant
Infant, Newborn
Male
Postoperative Complications
Pulmonary Valve / surgery*
Pulmonary Valve Insufficiency / surgery
Reoperation
Tetralogy of Fallot / surgery*

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


Previous Document:  Tetralogy of Fallot with subarterial ventricular septal defect.
Next Document:  Liberal use of tricuspid valve detachment for transatrial ventricular septal defect closure.