Insuficiencia pulmonar crónica secundaria a tetralogía de Fallot y estenosis pulmonar intervenida. Recambio valvular pulmonar con prótesis metálica

Abstract

Tetralogy of Fallot and pulmonary stenosis are a frequent cause of consultation in patients with congenital heart disease. Interventions performed in infancy can cause residual pulmonary insufficiency and may require pulmonary valve replacement when adults. From 2003 to 2007, 37 patients underwent right ventricular outflow tract or pulmonary valve intervention (tetralogy of Fallot and pulmonary stenosis). Differences between echocardiographic parameters in both pathologies, indications for pulmonary valvular replacement and the type of prosthesis used, were studied. 25 (67.6 %) patients had tetralogy of Fallot and 12 (32.4 %) pulmonary stenosis. In the pulmonary stenosis group, 7 patients had pulmonary valvulotomy in infancy and 5 had percutaneous pulmonary valvuloplasty in adulthood. Fallot patients received a transannular patch. No significant differences were seen in echocardiographic parameters (right and left ventricular diameter, pulmonary insufficiency, transpulmonary gradient and left ventricular ejection fraction). Mechanical prosthesis valve replacement was performed in 5 (13.5 %) patients, with no morbidity-mortality and with a significant improvement of the functional class. Chronic pulmonary insufficiency is a frequent complication after intervention of tetralogy of Fallot and pulmonary stenosis. Mechanical prosthesis valve replacement has low morbidity-mortality and low risk of complications after short to medium-term follow-up.