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Late valve implantation for pulmonary insufficiency after repair of tetralogy of Fallot

Late valve implantation for pulmonary insufficiency after re...

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全国心脏瓣膜外科学术会议

作者： Jorge Salazar lars nolke Anthony Azakie Tom R．Karl MD Division of Pediatric Cardiothoracic Surgery University of California San Francisco USA

Background Pulmonary insufficiency is usually well tolerated after repair of tetralogy of Fallot (TOF) . Many accepted surgical options for repair of TOF will result in some degree of pulmonary insufficiency. This may result in late, progressive right ventricular dilation and dysfunction, with increasing fatigue, lower limb edema, arrhythmias, and sudden *** Our objective was to review our experience with late pulmonary valve implantation (PVI) after repair of TOF and to evaluate the relative benefits and risks of operation. Methods. Patients who underwent late PVI after TOF repair from June, 2002 to April 30, 2004 were reviewed. Sources included patients’ hospital charts and echocardiograms. Follow - up was performed by the primary cardiologist. Results Ten patients had elective, late PVI. Average time after initial repair was 20.0 years (range 1,5 - 43 years, median 19 years) . There was no hospital mortality and all patients demonstrated significant symptomatic improvement. Pre - operatively, 9 of 10 patients were in New York Heart Association class Ⅲ - IV. After PVI, all patients were in class Ⅰ - Ⅱ (average class improvement of 1.7) . Left ventricular ejection fraction was significantly improved (EF from 62.1 ± 4.7 % to 70.2 ±4.9 ％, p =0.0001), as was fractional shortening (34.0±5.0 ％ to 40.0 ±4.2 ％, p = 0.01) . Right ventricular diameter also decreased significantly (from 32.3 ± 7.5 mm to 24.4 ±5.4 mm, p = 0.0005) . All PVI were performed with Carpentier - Edwards bovine pericardial prostheses, with sizes ranging from 19 mm to 27 mm. Average hospital stay was 5.4 days (range 4-7 days) . One patient had preoperative ventricular fibrillation, requiring resuscitation and an implantable cardiac defibrillater (ICD) before PVI, and another patient needed ICD at the time of PVI because of ventricular arrhythmias. After PVI, patients’ QRS duration decreased significantly (155.2 ± 27.1 to 140±21.2, p = 0.048) . The mean follow-up period was 12.5 months (ran

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