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The Journal of Thoracic and Cardiovascular Surgery, Vol 93, 36-44, Copyright © 1987 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
MN Ilbawi, FS Idriss, SY DeLeon, AJ Muster, SS Gidding, TE Berry and MH Paul
Postoperative cardiac catheterization data of 74 patients with pulmonary
insufficiency after tetralogy repair were analyzed. Two groups were
identified: Group A, 26 patients with normal right ventricular function
(ejection fraction 95% +/- 5.5%, end-systolic volume 110% +/- 17% of
predicted normal) and Group B, 48 patients with right ventricular
dysfunction (ejection fraction 80% +/- 18% [p less than 0.001], and
end-systolic volume 218% +/- 75% of predicted normal [p less than 0.001]).
There was no significant difference between the two groups with respect to
frequency of previous palliative procedures, age at operative repair,
operative techniques, methods of myocardial protection, and follow-up
period. Right ventricular dysfunction in Group B was associated with
significant distal pulmonary stenosis (right ventricle-pulmonary artery
pressure gradient 28 +/- 13 torr in Group A versus 55 +/- 20 torr in Group
B, p less than 0.001), moderate pulmonary regurgitation (regurgitant
fraction 18% +/- 11% in Group A versus 32% +/- 10% in Group B, p less than
0.001), and large transannular outflow patch (ratio of patch diameter to
descending aorta diameter 1.31 +/- 0.16 in Group A versus 2.50 +/- 0.28 in
Group B, p less than 0.001). Pulmonary valve insertion was performed in 42
patients in Group B. Eighteen had subsequent cardiac catheterization. Right
ventricular function recovered completely (end-systolic volume 122% +/-
24%, and ejection fraction 92% +/- 7% of predicted) in five of six patients
(83%) who had valve insertion within the first 2 years after tetralogy
repair. In contrast, right ventricular function remained abnormal in all 12
patients who had valve insertion later than 2 years after tetralogy repair
(p less than 0.05). Patients with residual pulmonary stenosis and/or a
large transannular outflow patch are at risk for the development of right
ventricular dysfunction from pulmonary insufficiency after tetralogy
repair. Early correction of these residual lesions and control of pulmonary
insufficiency may prevent long-term deterioration in right ventricular
function.
ARTICLES
Factors that exaggerate the deleterious effects of pulmonary insufficiency on the right ventricle after tetralogy repair. Surgical implications
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