HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Petros Anagnostopoulos Anthony Azakie Nelson Alphonso Tom R. Karl Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Anagnostopoulos, P. Articles by Karl, T. R. Search for Related Content PubMed PubMed Citation Articles by Anagnostopoulos, P. Articles by Karl, T. R. Related Collections Valve disease Related Article

J Thorac Cardiovasc Surg 2007;133:640-647
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Pulmonary valve cusp augmentation with autologous pericardium may improve early outcome for tetralogy of Fallot

^a Division of Pediatric Cardiac Surgery, Pediatric Heart Center, University of California at San Francisco Children’s Hospital, San Francisco, Calif
^b Division of Pediatric Cardiology, Pediatric Heart Center, University of California at San Francisco Children’s Hospital, San Francisco, Calif.

Read at the Eighty-sixth Annual Meeting of The American Association for Thoracic Surgery, Philadelphia, Pa, April 29-May 3, 2006.

Received for publication April 21, 2006; revisions received September 23, 2006; accepted for publication October 9, 2006.

^_* Address for reprints: Tom R. Karl, MD, UCSF Department of Surgery, Division of Pediatric Cardiothoracic Surgery, 513 Parnassus Avenue, Suite S-549, Box 0117, San Francisco, CA 94143-0117. (Email: karlt{at}surgery.ucsf.edu).

Objectives: The transannular patch used to relieve right ventricular outflow tract obstruction in children with tetralogy of Fallot may result in pulmonary insufficiency. We hypothesized that pulmonary valve cusp augmentation with pericardium would decrease pulmonary insufficiency and improve the early outcome for transatrial–transpulmonary tetralogy of Fallot repair requiring transannular patch.

Methods: Since November 2001, 41 patients with tetralogy of Fallot and 2 patients with isolated pulmonary valve stenosis had relief of right ventricular outflow tract obstruction with either a transannular patch plus pulmonary valve cusp augmentation (n = 18) or a transannular patch alone (n = 25). Data were retrospectively collected.

Results: The median age (5.3 vs 3.2 months; P = .09) and weight (6.4 vs 5.2 kg; P = .3) were similar for the cusp augmentation and transannular patch groups, respectively. The diameter of the pulmonary valve annulus (6.4 vs 6.0 mm; P = .57) and the McGoon index (1.47 vs 1.69, P = .75) were also similar. The mean aortic clamp time (48 ± 18 minutes vs 52 ± 19 minutes; P = .46) and median cardiopulmonary bypass time (89 vs 91 minutes; P = .9) did not differ. One patient with a transannular patch died of multiorgan system failure. Patients with a pulmonary valve cusp augmentation had a shorter duration of intubation (1 vs 3 days; P < .001) and intensive care unit stay (2 vs 8 days; P < .001). Thirteen patients with a transannular patch and 1 patient with a pulmonary valve cusp augmentation required inotropic support for more than 72 hours (P = .001). Discharge echocardiograms demonstrated moderate or severe pulmonary insufficiency in 5 patients with a pulmonary valve cusp augmentation and in 21 patients with a transannular patch (P < .001). At 7.5 months, 3 patients (17%) with a pulmonary valve cusp augmentation had progression of pulmonary insufficiency.

Conclusions: Augmentation of a pulmonary valve cusp reduces the incidence of clinically significant postoperative pulmonary insufficiency. This technique may improve the early outcome for children with tetralogy of Fallot requiring a transannular patch.

Related Article

Discussion
J. Thorac. Cardiovasc. Surg. 2007 133: 646-647. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				E. W.K. Peng, S. Lilley, B. Knight, J. Sinclair, F. Lyall, K. MacArthur, J. C.S. Pollock, and M. H.D. Danton Synergistic interaction between right ventricular mechanical dyssynchrony and pulmonary regurgitation determines early outcome following tetralogy of Fallot repair Eur. J. Cardiothorac. Surg., October 1, 2009; 36(4): 694 - 702. [Abstract] [Full Text] [PDF]

				A. K. Kaza, H.-G. Lim, D. J. Dibardino, V. Bautista-Hernandez, J. Robinson, C. Allan, P. Laussen, F. Fynn-Thompson, E. Bacha, P. J. del Nido, et al. Long-term results of right ventricular outflow tract reconstruction in neonatal cardiac surgery: Options and outcomes J. Thorac. Cardiovasc. Surg., October 1, 2009; 138(4): 911 - 916. [Abstract] [Full Text] [PDF]

				M. Kestelli, E. Tulukoglu, I. I. Yurekli, and A. Gurbuz Think twice while inserting a transannular patch Eur. J. Cardiothorac. Surg., June 1, 2009; 35(6): 1112 - 1113. [Full Text] [PDF]

				G. R. Nunn, J. Bennetts, and E. Onikul Durability of hand-sewn valves in the right ventricular outlet. J. Thorac. Cardiovasc. Surg., August 1, 2008; 136(2): 290 - 296. [Abstract] [Full Text] [PDF]