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Pulmonary valve replacement with mechanical prostheses in re-do Fallot patients.
MedLine Citation:
PMID:  21429868     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
In this prospective clinical study, we have compared 17 patients with tetralogy of Fallot (TOF) who received mechanical valve substitutes and had concomitant additional right ventricular (RV) volume reduction plasty (aRVVRP, group 1) with seven patients who underwent solitary re-do pulmonary valve replacements (PVR, group 2). All patients were evaluated by magnetic resonance imaging (MRI) two months pre- and four to six months postoperatively for assessment of ventricular geometry. At a mean follow-up of 31.9 months, the RV ejection fraction improved from 39.1 to 48.3% in group 1 vs. from 40.1 to 49% in group 2 (P<0.001), and RV indexed end-diastolic volume decreased from 174.8 to 119.9 ml/m(2) (group 1) vs. from 142.4 to 99.6 ml/m(2) (group 2, P<0.001). Indexed RV myocardial mass decreased from 52.3 to 38.7 g/m(2) in group 1 vs. 46.9 to 39.1 g/m(2) in group 2 (P<0.001). Follow-up revealed no mortality and distinct improvements in RV geometry, recommending mechanical prostheses as suitable alternatives for PVR. Selection criteria for this solution should consider multiple previous reoperations and assured patient compliance considering current anticoagulants usage and self-testing. aRVVRP could serve as an adjunct in re-dos of TOF surgery indicated by RV outflow tract dysfunction due to akinetic fibrous areas. Keywords: Congenital heart disease; Right ventricular outflow tract reconstruction; Pulmonary valve replacement; Mechanical prosthesis; Right ventricular volume reduction plasty; Reoperation.
Authors:
Ismar Ovcina; Igor Knez; Pero Curcic; Sezen Ozkan; Bert Nagel; Erich Sorantin; Markus Puchinger; Karlheinz Tscheliessnigg
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-3-22
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  -     ISSN:  1569-9285     ISO Abbreviation:  -     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-3-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Division of Cardiac Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
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