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J Thorac Cardiovasc Surg 1996;112:33-37
© 1996 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

SHORT-TERM EFFECT OF MONOCUSPID VALVES ON PULMONARY INSUFFICIENCY AND CLINICAL OUTCOME AFTER SURGICAL REPAIR OF TETRALOGY OF FALLOT

From The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

Received for publication Oct. 9, 1995 revisions requested Dec. 4, 1995; revisions received Jan. 4, 1995 Accepted for publication Jan. 9, 1995. Address for reprints: Christine Boutin, MD, Division of Cardiology, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada M5G 1X8.

Abstract

In the surgical repair of tetralogy of Fallot, monocuspid valves are sometimes inserted within a transannular patch to prevent pulmonary insufficiency. To determine whether this monocuspid valve prevents short-term postoperative pulmonary insufficiency and improves clinical outcome, we reviewed clinical data and preoperative and postoperative echocardiographic variables from 61 patients who underwent one of three different procedures for repair of tetralogy of Fallot between August 1992 and March 1994. We compared features from 24 patients who had undergone transannular patch repair with a monocuspid valve (patch-valve) with those from 17 patients who had undergone patch repair without a monocuspid valve (patch) and 20 patients who had undergone repair without a transannular patch (no patch). We used the ratio of pulmonary valve insufficiency jet width to pulmonary artery diameter, as measured by color-flow Doppler flowmetry, as an index of severity of pulmonary insufficiency. Moderate to severe pulmonary insufficiency was arbitrarily defined as a ratio of at least 0.50. We found no significant differences in ratios among the patch-valve group (0.73 ± 0.25, mean ± standard deviation), the patch group (0.79 ± 0.20), and the no patch group (0.59 ± 0.23). The percentages of patients with moderate to severe pulmonary insufficiency did not differ among the three groups (patch-valve 80%, patch 90%, no patch 64%). Clinical data (including mortality, number of reoperations, intensive care unit and hospital lengths of stay, and postoperative hemodynamics) were similar in the three groups. We conclude that insertion of a monocuspid valve in repair of tetralogy of Fallot does not prevent short-term postoperative pulmonary insufficiency and does not improve immediate postoperative outcome for these patients. (J THORAC CARDIOVASC SURG 1996;112:33-7)

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