Abstract
Objective: The study aims to establish a new method in the Tetralogy of Fallot (ToF) called the pulmonary valve bi-orifice method (pulmonary annular sparing with an individualized autologous pericardial patch; thus, two orifices are formed at the level of the pulmonary valve annulus) to reconstruct the right ventricular outflow tract (RVOT).Methods: A retrospective analysis of 128 TOF patients from October 2009 to June 2018 with severe pulmonary valve dysplasia who underwent transvalvular annular patch (TAP) procedure (control group) or an individualized pulmonary valve bi-orifice procedure (observation group) were studied. The RVOT for each patient in the observation group was individually reconstructed per the patient's weight and the size of the autologous pulmonary valve using the bi-orifice method; however, increasing the cross-sectional area of the pulmonary valve annulus without destroying its integrity. The result was then compared to the control group, where TAP procedures were applied to evaluate the short to mid-term outcome(s). An in vitro simulation test was used to verify the anti-regurgitation mechanism of the new method.Results: The in vitro simulation test indicated that the anti-regurgitation mechanism was completed by the pericardial patch and the autologous pulmonary valve movement toward each other. Thus, for clinical applications, patients in both groups were compared. The results showed no significant differences in cardiopulmonary bypass and aortic cross-clamp time, mechanical ventilation, and ICU and post-operative residence between the two groups.During the follow-up period (3- to 12-years), 14 patients in the observation group had mild regurgitation after surgery (22.2%), while 10 patients had moderate pulmonary regurgitation (15.8%) with no right ventricular (RV) dilation. On the other hand, 22 patients (39.6%) had moderate to severe regurgitation in the control group, while left pulmonary artery stenosis occurred in one patient. In the control group, six patients (9.2%) with severe RV dilation were reoperated.Conclusion: Individualized pulmonary valve bi-orifice procedure is a safe and excellent method for reconstructing RVOT in ToF.
Highlights
Tetralogy of Fallot (ToF) is the most prevalent cyanotic congenital heart disease in pediatric cardiac surgery, accounting for 12–14% of all congenital heart diseases, with surgery currently the only way of treating ToF
Though stenosis in the right ventricular outflow tract (RVOT) is alleviated with the procedure; subsequent severe pulmonary regurgitation is encountered few years after the procedure, even worse than the initial residual stenosis [3]
Though moderate regurgitation occurred in 10 patients (15.8%), no patient presented with right ventricular (RV) dilation
Summary
Tetralogy of Fallot (ToF) is the most prevalent cyanotic congenital heart disease in pediatric cardiac surgery, accounting for 12–14% of all congenital heart diseases, with surgery currently the only way of treating ToF. The first adopted surgical procedure have always included incision of the pulmonary valve annulus and a transannular patch (TAP) to widen the dysplastic pulmonary valve [1], and achieved short-term favorable results [2]. Though stenosis in the RVOT is alleviated with the procedure; subsequent severe pulmonary regurgitation is encountered few years after the procedure, even worse than the initial residual stenosis [3]. Procedures such as the valve-spring technique have been used to improve the setbacks. We developed a new procedure to partially separate the pulmonary annulus from the pulmonary arterial wall, preserving its integrity and using a pericardial patch to widen the RVOT
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