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General Thoracic and Cardiovascular Surgery

Published in:

01-06-2012 | Original Article

Pulmonary valve replacement long after repair of tetralogy of Fallot

Authors: Yuichi Shiokawa, Hiromichi Sonoda, Yoshihisa Tanoue, Takahiro Nishida, Atsuhiro Nakashima, Ryuji Tominaga

Published in: General Thoracic and Cardiovascular Surgery | Issue 6/2012

Abstract

Purpose

Pulmonary valve replacement long after repair of tetralogy of Fallot can improve cardiac function, functional status, and arrhythmia propensity. This has not been reported in Japan. We aim to evaluate the effects of pulmonary valve replacement in repaired tetralogy of Fallot.

Methods

Nineteen patients underwent pulmonary valve replacement after repair of tetralogy of Fallot, excluding Rastelli type operation, between August 1981 and August 2011. The results of the pulmonary valve replacement were assessed by analyzing preoperative and postoperative cardiothoracic ratio, cardiac function, functional status, QRS duration and durability of the prosthetic valves.

Results

There were neither operative nor late deaths. The Cardiothoracic ratio significantly improved from 61.0 ± 5.2 % preoperatively to 56.2 ± 4.8 % postoperatively (P < 0.001). The New York Heart association functional class significantly improved from 2.4 ± 0.8 preoperatively to 1.2 ± 0.4 postoperatively as well. Left ventricular ejection fraction showed significant improvement. QRS duration showed significant reduction. The freedom redo pulmonary valve replacement at 20 years was 100 %.

Conclusion

Pulmonary valve replacement long after repair of previous tetralogy of Fallot had clinical benefits with low mortality. We recommend bioprosthesis for pulmonary valve replacement when adult-sized valve can be accommodated.

Scherptong RW, Hazekamp MG, Mulder BJ, Wijers O, Swenne CA, van der Wall EE, et al. Follow-up after pulmonary valve replacement in adults with tetralogy of Fallot: association between QRS duration and outcome. J Am Coll Cardiol. 2010;26(56):1486–92.CrossRef

Lim C, Lee JY, Kim WH, Kim SC, Song JY, Kim SJ, et al. Early replacement of pulmonary valve after repair of tetralogy: is it really beneficial? Eur J Cardiothorac Surg. 2004;25:728–34.PubMedCrossRef

Therrien J, Siu SC, Harris L, Dore A, Niwa K, Janousek J, et al. Impact of pulmonary valve replacement on arrhythmia propensity late after repair of tetralogy of Fallot. Circulation. 2001;103:2489–94.PubMed

Harrild DM, Berul CI, Cecchin F, Geva T, Gauvreau K, Pigula F, et al. Pulmonary valve replacement in tetralogy of Fallot: impact on survival and ventricular tachycardia. Circulation. 2009;119:445–51.PubMedCrossRef

Discigil B, Dearani JA, Puga FJ, Schaff HV, Hagler DJ, Warnes CA, et al. Late pulmonary valve replacement after repair of tetralogy of Fallot. J Thorac Cardiovasc Surg. 2001;121:344–51.PubMedCrossRef

Miyazaki T, Yamagishi M, Nakashima A, Fukae K, Nakano T, Yaku H, et al. Expanded polytetrafluoroethylene valved conduit and patch with bulging sinuses in right ventricular outflow tract reconstruction. J Thorac Cardiovasc Surg. 2007;134:327–32.PubMedCrossRef

Gatzoulis MA, Till JA, Somerville J, Redington AN. Mechanoelectrical interaction in tetralogy of Fallot. QRS prolongation relates to right ventricular size and predicts malignant ventricular arrhythmias and sudden death. Circulation. 2001;92:231–7.

Frigiola A, Redington AN, Cullen S, Vogel M. Pulmonary regurgitation is an important determinant of right ventricular contractile dysfunction in patients with surgically repaired tetralogy of Fallot. Circulation. 2004;110:II153–7.

Tobler D, Crean AM, Redington AN, Van Arsdell GS, Caldarone CA, Nanthakumar K, et al. The left heart after pulmonary valve replacement in adults late after tetralogy of Fallot repair. Int J Cardiol. 2011 [Epub ahead of print].

10.

Tokunaga S, Masuda M, Shiose A, Tomita Y, Morita S, Tominaga R. Isolated pulmonary valve replacement: analysis of 27 years of experience. J Artif Organs. 2008;11:130–3.PubMedCrossRef

11.

McClure RS, Narayanasamy N, Wiegerinck E, Lipsitz S, Maloney A, Byrne JG, et al. Late outcomes for aortic valve replacement with Carpentier-Edwards pericardial bioprosthesis: up to 17-year follow-up in 1000 patients. Ann Thorac Surg. 2010;89:1410–6.PubMedCrossRef

12.

Borger MA, Ivanov J, Armstrong S, Christie-Hrybinsky D, Feindel CM, David TE. Twenty-year results of the Hancock II bioprosthesis. J Heart Valve Dis. 2006;15:49–55.PubMed

13.

Lee C, Park CS, Lee CH, Kwak JG, Kim SJ, Shim WS. Set al. Durability of bioprosthetic valves in the pulmonary position: long-term follow-up of 181 implants in patients with congenital heart disease. J Thorac Cardiovasc Surg. 2011;142:351–8.PubMedCrossRef

14.

Manji RA, Zhu LF, Nijjar NK, Rayner DC, Korbutt GS, Churchill TA, et al. Glutaraldehyde-Fixed bioprosthetic heart valve conduits calcify and fail from xenograft rejection. Circulation. 2006;114:318–27.PubMedCrossRef

15.

16.

Gengsakul A, Harris L, Bradley TJ, Webb GD, Williams WG, Siu SC, et al. The impact of pulmonary valve replacement after tetralogy of Fallot repair: a matched comparison. Eur J Cardiothorac Surg. 2007;32:462–8.PubMedCrossRef

17.

Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP Jr, Freed MD, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol. 2006;48:e1–148.PubMedCrossRef

Title: Pulmonary valve replacement long after repair of tetralogy of Fallot
Authors: Yuichi Shiokawa
Hiromichi Sonoda
Yoshihisa Tanoue
Takahiro Nishida
Atsuhiro Nakashima
Ryuji Tominaga
Publication date: 01-06-2012
Publisher: Springer Japan
Published in: General Thoracic and Cardiovascular Surgery / Issue 6/2012
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI: https://doi.org/10.1007/s11748-012-0056-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Pulmonary valve replacement long after repair of tetralogy of Fallot

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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