IMMEDIATE AND EARLY OUTCOME OF PULMONARY VALVE CUSP AUGMENTATION FOR REPAIR OF TETRALOGY OF FALLOT (TOF)

Abstract

Objectives: To determine the immediate and early outcome of pulmonary valve cusp augmentation for repair of tetralogy of Fallot (TOF)
 Methods: A descriptive study of 36 cases of TOF repair done from July 2020 to December 2022 at Faisalabad Institute of cardiology (FIC). Autologous pericardium used in all cases to augment the pulmonary valve cusp to increase the size of pulmonary valve orifice. Patients were followed in immediate and early post operative period by doing echocardiography to observe the outcome including pulmonary valve regurgitation (PR), stenosis and right ventricular outflow tract obstruction (RVOTO)
 Results: Median age was 12 years (4–21). Immediate Post repair echocardiography showed no PR in 77.8 % of patients (n=28) while 8 patients had mild PR (22.2%). Majority of patients (61.1%) had mild RVOT obstruction, 13 patients (36.1%) had moderate RVOT obstruction while one patient had severe RVOT obstruction. Mean gradient across RVOT was 36.72 (+/- 11.08). The data on most recent follow up showed no PR in 83.3% (n=30) patients, while 6 patients (16.7%) had mild pulmonary regurgitation. Mild RVOTO was seen in 47.2 % of patients (n=17), 50% (n=18) patients had moderate RVOTO while one patient had severe RVOTO. Mean RVOT gradient was 40.8 +/- 15.20. There was no statistically significant difference between immediate and at last follow up RVOT gradient (p-value = 0.119)
 Conclusion: Augmentation of the pulmonary valve cusp in selective cases of TOF is a useful technique to avoid the need of transannular patch in significant number of cases
 Keywords: Tetralogy of Fallot, right ventricular outflow tract, cusp augmentation, transannular.