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J Thorac Cardiovasc Surg 1998;115:1074-1078
© 1998 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

Mechanical valves in the pulmonary position: A reappraisal

From the Department of Pediatric Cardiology/Cardiac Surgery, San Donato Hospital,^a San Donato Milanese; the Department of Pediatrics, Regina Elena Hospital,^b Milan; and the Department of Pediatric Cardiology, Ospedale Pediatrico Apuano,^c Massa, Italy.

Received for publication July 18, 1997. Revisions requested Sept. 17, 1997; revisions received Dec. 1, 1997. Accepted for publication Dec. 9, 1997. Address for reprints: Luca Rosti, MD, Ospedale San Donato, via Morandi 30, 20097 San Donato Milanese, Milan, Italy.

Objectives: To evaluate midterm results of mechanical valves in pulmonary position in patients with pulmonary regurgitation and right ventricular dysfunction as an alternative to bioprostheses. Patients: Mechanical valves (six tilting disc valves and two bileaflet valves) were implanted in eight patients previously operated on for tetralogy of Fallot (n = 7) and truncus arteriosus (n = 1), with severe right ventricular dysfunction caused by massive pulmonary regurgitation. Results: All patients survived prosthesis implantation and are currently well. At follow-up (3 months to 9 years), they do not show signs of valve failure, and right ventricular function has dramatically improved in all but one, who still shows moderate ventricular hypokinesia. Conclusion: After operative correction of congenital heart defects in selected patients who show severe dysfunction of the right ventricle caused by pulmonary regurgitation/stenosis, mechanical valves may represent an alternative to bioprosthetic valves. The selection of the valve type is still a matter of debate. However, according to literature data, complications seem to have occurred only in patients with bileaflet mechanical valves in the pulmonary position, whereas no thromboembolic episodes or valve failure is reported in subjects with tilting disc valves in the right ventricular outflow. Tilting disc valves might perform better in the right ventricular outflow than bileaflet valves.

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