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Late Pulmonary Valve Replacement after Correction of Fallot's Tetralogy
- Source :
- The Thoracic and Cardiovascular Surgeon. 52:23-28
- Publication Year :
- 2004
- Publisher :
- Georg Thieme Verlag KG, 2004.
-
Abstract
- BACKGROUND The aim of this study was to investigate necessity and outcome of late pulmonary valve replacement (PVR) after repair of tetralogy of Fallot (TOF). METHODS Hospital records from patients operated on for TOF at our institution between 1960 and 2002 were reviewed and patients were interviewed by questionnaires. RESULTS Out of 411 long-term survivors after TOF-repair, 47 (11.4 %) patients required reoperation after 13.2 +/- 7.4 years. Preoperative right ventricular (RV) dilatation was present in 36 (76.6 %) patients including 16 (34 %) with impaired RV function. Isolated PVR was performed in 12 patients (25.5 %). Additional procedures were necessary in 35 patients (74.5 %), including closure of residual defects (VSD, n = 11), tricuspid valve replacement (n = 1) and repair (n = 3). Obstructive right ventricular or pulmonary artery lesions (34 patients, 72.3 %) were all surgically addressed. RV pressure decreased from 61.1 +/- 27.7 to 42.9 +/- 13.3 mm Hg (p < 0.01) after PVR. RV size was reduced and RV function improved compared to preoperative values. Early mortality after reoperation was 2.1 % (n = 1) with one patient dying from biventricular failure. There was no late mortality. CONCLUSIONS PVR after Fallot repair is frequently required because of progressive RV enlargement with dysfunction. It can be performed with relatively low risk, even in the setting of multiple reoperation. Obstructive lesions (RVOTO, PA stenosis) and residual defects are frequently observed in patients needing late PVR and may play a crucial role in the development of RV failure. Timely valve replacement with repair of all obstructive lesions proximal and distal to the implanted valve is the key to preserving RV function.
- Subjects :
- Adult
Reoperation
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Time Factors
Adolescent
medicine.medical_treatment
Severity of Illness Index
Postoperative Complications
Valve replacement
Germany
medicine.artery
Internal medicine
Pulmonary Valve Replacement
Severity of illness
Ventricular Pressure
Humans
Medicine
Tetralogy
Child
Retrospective Studies
Tetralogy of Fallot
Heart Failure
Heart Valve Prosthesis Implantation
Pulmonary Valve
Exercise Tolerance
business.industry
Infant
Stroke Volume
Retrospective cohort study
Length of Stay
medicine.disease
Pulmonary Valve Insufficiency
Tricuspid Valve Insufficiency
Stenosis
Treatment Outcome
Child, Preschool
Pulmonary artery
Cardiology
Surgery
Cardiology and Cardiovascular Medicine
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 14391902 and 01716425
- Volume :
- 52
- Database :
- OpenAIRE
- Journal :
- The Thoracic and Cardiovascular Surgeon
- Accession number :
- edsair.doi.dedup.....1e60ea718f79df5894e8bb8cef2fe631
- Full Text :
- https://doi.org/10.1055/s-2004-817798