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There have been few reports about degenerated monocusp-valve patches, which were used for right ventricular outflow tract( RVOT) reconstruction with complications of infective endocarditis after total correction of tetralogy of Fallot( TOF).A 44-year-old male patient, who had a total correction of TOF using Monocusp Valved Outflow Patch (MVOP) 34 years previous, was admitted for heart failure with aortic regurgitation. An echocardiographic study showed an infective endocarditis with vegetations, attached to the aortic valve and the monocusp-valve outflow patch. The aortic valve was replaced with a mechanical prosthesis and the pulmonary valve was replaced with a biological prosthesis. RVOT was reconstructed using a bovine pericardial patch. The explanted monocusp-valve was deteriorated and heavily calcified. The postoperative course was uneventful. The patient was discharged and returned to his preoperative lifestyle 36 days after the redo surgery.

Pulmonary regurgitation(PR) and right ventricular dysfunction are the major complications in a longterm period after the repair of congenital heart diseases including tetralogy of Fallot(TOF). The purpose of this study is to investigate the effectiveness of pulmonary valve replacement (PVR) after the congenital heart repair. Twenty-five patients undergoing PVR for PR with clinical symptoms in a longterm period between March 2008 and December 2016 were retrospectively reviewed. The average age at the TOF repair was 2.6±2.6 years. The average age at the PVR was 21.6±11.2 years. The mean follow-up after the PVR was 52.8±27.5 months. There was neither hospital death nor late death. All the patients underwent PVR with a bio-prosthetic valve. Nine patients had concomitant tricuspid valve repair. PVR significantly reduced right ventricular end-diastolic volume( RVEDVI)[ 123±25 vs 101± 13% of normal, p=0.002], cardio-thoracic ratio (CTR) [56.0±6.9 vs 52.6±13.0%, p=0.03], and brain natriuretic peptide (BNP) [57.6±57.0 vs 38.7±31.3 pg/dl, p=0.03]. The relatively early PVR significantly improved RVEDVI, CTR and cardiac function.

Almost 90% of children with congenital heart disease now reach adulthood due to the improved results of cardiac surgery and medical treatment. Among them, one of particular problems is pulmonary valve regurgitation after tetralogy of Fallot repair. About 20 years ago (1996), the mortality of tetralogy of Fallot has already been relatively good at about 5%, but now it is further reduced to about 2%. For this reason, it is conceivable that more and more adult patients with tetralogy of Fallot will increase in the future. Pulmonary valve regurgitation is often caused by the use of transannular patch repair. Surgical indications for pulmonary valve regurgitation include those with decreased exercise tolerance, right ventricular dysfunction, advanced right ventricular enlargement. We examined treatment strategies, valve selection and catheter valve implantation.

We present a rare case of papillary fibroelastoma arising from the pulmonary valve. A 45-year-old man had been suffered from palpitation. Transthoracic echocardiography clearly demonstrated a mobile rounded mass in the right ventricular outflow tract. He underwent surgical extirpation of the tumor. A fragile, yellow tumor on the pulmonary valve was recognized at operation. The pulmonary valve was repaired with autologous pericardium. Operation was performed successfully. The diagnosis as a papillary fibroelastoma was made by histopathological examination. The post-operative course was uneventful and echocardiography showed no residual tumor of the heart.

Blood cysts of the heart valves are commonly reported at postmortem examination of infants but are rare seen in older children and adults. A 42-year-old woman was referred to our hospital for cardiac evaluation because of dyspnea on exertion and heart murmur. There was no history of cyanosis or cardiac failure. Cardiac catheterization revealed valvular pulmonary stenosis and atrial septal defect. Right ventricular angiography showed the circular filling defect 0.7 x 0.7 cm in size at the suprapulmonary valve. However, this preoperative abnormal finding was diagnosed as a blood cyst after surgery. At operation a blood cyst originating from the right cusp of the pulmonary valve was found and resected, and was followed by commissurotomy of the pulmonary valve and direct closure of the atrial septal defect. Her postoperative course was uneventful.

Clinical results with mechanical and bioprosthetic valve replacements for tricuspid and/or pulmonary positions were reviewed. Between February 1975 and December 1985, 34 bioprostheses (B) (22 Hancock, 9 Ionescu-Shiley and 3 Carpentier-Edwards pericardial) and 18 mechanical prostheses (M) (St. Jude Medical) were implanted in our institute excluding hospital death. Group with B included 29 tricuspid valve replacements and 5 pulmonary valve replacements. Group with M included 9 tricuspid valve replacements, 7 pulmonary valve replacements and 1 both valve replacements. The cumulative follow-up period was 207.2 patient-years (p-t) in group B and 55.0 p-y in group M. The incidence of valve failure was 0.48 +/- 0.48% per p-y in group B and 7.27 +/- 3.64% per p-y in group M (p less than 0.001). The incidence of valve-related events was 1.93 +/- 0.97% per p-y in group B and 9.09 +/- 4.07% per p-y in group M (p less than 0.001). At 3 years, the percent free of valve failure was 100 +/- 0% in group B and 76.8 +/- 10.2% in group M (p less than 0.05). Fourteen bioprosthetic valves (B') and 10 mechanical valves (M') were implanted at the right-sided cardiac valve position alone. The cumulative follow-up period was 94.2 p-y in group B' and 32.3 p-y in group M'. The incidence of valve-related events was 1.06 +/- 1.06% per p-y in group B' and 12.4 +/- 6.19% per p-y in group M' (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)