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Surgical outcome after complete repair of tetralogy of fallot with absent pulmonary valve: comparison between bovine jugular vein-valved conduit and monocusp-valve patch

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World Journal of Pediatrics 2018年第5期14卷 510-519页

作者： En-Shi Wang Xue-Song Fan Li Xiang Shou-Jun Li Hao Zhang Center for Pediatric Cardiac Surgery National Center for Cardiovascular Diseases and Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China Department of Clinical Laboratory Center Beijing An Zhen HospitalCapital Medical UniversityBeijing Institute of HeartLung and Blood Vessel DiseasesBeijing 100029China

Background The prognosis of tetralogy of fallot with absent pulmonary valve (TOF/APV) without operation is poor. We evaluated the surgical outcome of TOF/APV in a single center. Methods Twenty-two TOF/APV patients underwent complete surgical correction in our hospital. Right ventricular outflow tract reconstruction was performed using bovine jugular vein (BJV)-valved conduit implantation (n=10), homograft-valved conduit implantation (n=2), or monocusp-valve patch (n=10). Health-related quality of life (QOL) was evaluated during follow-up. Results The overall survival at 5 and 10 years was 86.4±7.3% (confidence interval 69.4–97.2%). The survival rates were significantly different between patients with and without bronchial stenosis (40 and 100%, P=0.0003, log-rank test). The survival of patients aged>6 months was higher than those≤6 months (100 vs. 40%, P=0.0003, log-rank test). Patients with BJV-valved conduits had higher systolic gradients from the right ventricle to the pulmonary artery (RV–PA) compared to those with monocusp-valve patches. BJV-valved conduit implantation was a risk factor for post-operative pulmonary-valve stenosis. The QOL score for patients with BJV-valved conduits was lower than those with monocusp-valve patches (P<0.05). No reoperation was performed during follow-up. Conclusions Bronchial stenosis and lower age (≤6 months) were the main factors influencing post-operative survival. The use of a BJV-valved conduit was a main reason for RV–PA restenosis;thus, the use of a BJV-valved conduit may increase the need for repeat intervention and decrease the post-operative quality of life.

关键词： Bovine jugular vein-valved conduit Bronchial stenosis Pulmonary stenosis Tetralogy of fallot with absent pulmonary valve

Evaluation of pulmonary regurgitation by using different cardiac magnetic resonance indices in children with repaired tetralogy of fallot

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Chinese Medical Journal 2019年第7期132卷 877-879页

作者： Qiong Yao Quan-Li Shen Xi-Hong Hu Zhong-Wei Qiao Guo-Ying Huang Department of Radiology Children's Hospital of Fudan UniversityShanghai 201102China Cardiac Center Children's Hospital of Fudan UniversityShanghai 201102China

To the Editor:Nowadays,most infants with tetralogy of fallot(TOF)survive the initial surgical repair;however,they continue to experience residual hemodynamic and physiologic abnormalities in the follow-up.[1]Pulmonary regurgitation(PR)is still recognized as the most common complication that determines late outcomes.PR may result in right ventricular(RV)dilatation and,ultimately,cardiac dysfunction.Indicators of deterioration of clinical status such as impaired exercise tolerance,ventricular arrhythmia,and sudden cardiac death have all been associated with chronic PR.

关键词： pulmonary regurgitation repaired tetralogy of fallot tetralogy of fallot(TOF)

Current outcomes and treatment of tetralogy of fallot

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Life Research 2022年第3期5卷 55-68页

作者： Manish Juneja Pankaj Raut Harshawardhan Dhanraj Ramteke Vaishnavi Jayant Walke Cardiac ICU and Department of Cardiology Rhythm Heart and Critical CareNagpurIndia School of International Education Anhui Medical UniversityHefeiChina and Cardiac ICU and Department of CardiologyRhythm Heart and Critical CareNagpurIndia School of International Education Anhui Medical UniversityHefeiChina

One of the most common types of cyanotic congenital heart disease is Tetralogy of fallot(ToF).Treatment has constantly increased since the first surgical repair in 1954.Excellent treatment having long-term survival(30 years survival ranges from 68.5%to 90.5%)is available for the ToF.However conventional and frequently required re-interventions include residual issues like right ventricular outflow tract obstruction,pulmonary regurgitation and(ventricular)arrhythmia.Right ventricular dysfunction might lead to longstanding pulmonary regurgitation and/or stenosis.It is important to perform pulmonary valve replacement or relief of pulmonary stenosis prior to irreversible right ventricular dysfunction,though determining optimal timing of pulmonary valve replacement is a problematic task due to various reasons.As seen in longstanding pulmonary regurgitation,the biological mechanisms underlying dysfunction of the right ventricle is often unclear.Various techniques of assessing the right ventricle are used to predict imminent dysfunction.The interventricular,ventriculo-arterial and atrioventricular interactions of right ventricle are not completely explained but play significant role in right ventricle performance.This review focuses on providing a brief overview of the history of ToF,describing the current strategies for treatment and describing the long-term survival,residual lesions and re-interventions following repair.Remaining related challenges and present condition of the art regarding these challenges are also illustrated.

关键词： Tetralogy fallot congenital heart disease survival outcomes

Anisotropic Models of Human Pulmonary Root with Bicuspid Pulmonary Valve in Patients with Tetralogy of fallot: Pulmonary Root Function Assessment and Mechanical Stress Analysis

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医用生物力学 2019年第A1期34卷 88-89页

作者： Caili Li Christopher Baird Jing Yao Chun Yang Liang Wang Han Yu Tal Geva Dalin Tang School of Mathematics Southeast UniversityNanjing210096China Department of Cardiac Surgery BostonChildren's HospitalHarvard Medical SchoolBostonMAUSA Department of Cardiology First Affiliated Hospital ofNanjing Medical UniversityNanjing210029China China Information Tech.Designing&Consulting Institute Co. Ltd.Beijing100048China School of Biological Science&Medical Engineering Southeast UniversityNanjingChina Department of Cardiology Boston Children's HospitalDepartment of PediatricsBostonMA USA MathematicalSciences Department Worcester Polytechnic InstituteWorcesterMA01609USA

Background Tetralogy of fallot(TOF)is the most common cyanotic heart defect,accounting for 10%of all congenital defects.Pulmonary valve stenosis(PVS)is one common right ventricular outflow tract obstruction problem in patients with TOF.Congenital bicuspid pulmonary valve(BPV)is a condition of valvular stenosis,which morphologic feature is the presence of only two pulmonary leaflets instead of the normal tri-leaflet.Congenitally BPV are uncommon and the occurrence is often associated with TOF.Methods The three-dimensional geometric reconstruction of pulmonary root(PR)were based on well-accepted mathematical analytic models with physiological parameters obtained from a typical sample of the pulmonary root used in clinical surgery.The PR geometry included valvular leaflets,sinuses,interleaflet triangles and annulus.The dynamic computational models of normal PR with tri-leaflet and PR with BPV in patients with TOF were developed to investigate the effect of geometric structure of BPV on valve stress and strain distributions and the geometric orifice area.Mechanical properties of pulmonary valve leaflet were obtained from biaxial testing of human pulmonary valve left leaflet,and characterized by an anisotropic Mooney-Rivlin model.The complete cardiac cycle was simulated to observe valve leaflet dynamic stress and strain behaviors.Results Our results indicated that stress/strain distribution patterns of normal tri-leaflet pulmonary valve(TPV)and the BPV were different on valve leaflets when the valve was fully open,but they were similar when valves were completely closed.When the valve was fully open,the BPV maximum stress value on the leaflets was 218.1 kPa,which was 128.0%higher than of the normal TPV value(95.6 kPa),and BPV maximum strain value on the leaflets was 70.7%higher than of the normal TPV.The location of the maximum stress from TPV and BPV were also different,which were found at the bottom of the valve near the leaflet attachment for TPV and the vicinity of cusp of the fusion of two leaflets for BPV,respec

关键词： anisotropic model pulmonary root bicuspid pulmonary valve tetralogy of fallot

Improving Right Ventricle Cardiac Function for Repaired Tetralogy of fallot Patient with Contracting Bands: A Modelling Study

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医用生物力学 2019年第A1期34卷 83-84页

作者： Han Yu Tal Geva Rahul HRathod Chun Yang Zheyang Wu Kristen LBilliar Xueying Huang Dalin Tang School of Biological Science&Medical Engineering Southeast UniversityNanjingChina Department of Cardiology Boston Children’s HospitalHarvard Medical SchoolBostonMAUSA Mathematical Sciences Department Worcester Polytechnic InstituteWorcesterMAUSA Department of Biomedical Engineering Worcester PolytechnicInstituteMAUSA School of Mathematical Sciences Xiamen UniversityXiamenChina

Objective Patients with repaired tetralogy of fallot(rTOF)account for the majority of cases with late onset right ventricle(RV)failure.The current surgical approach,including pulmonary valve replacement/insertion(PVR),has yielded mixed results with some patients recover RV function and some do not.An innovative surgical approach was proposed to help ventricle to contract and improve RV function qualified by ejection fraction with one or more active contracting bands.Computational biomechanical modelling is a widely used method in cardiovascular study for investigation of mechanisms governing disease development,quantitative diagnostic and treatment strategies and improving surgical designs for better outcome.Muscle active contraction caused by zero-load sarcomere shortening leads to change of zero-load configurations.In lieu of experimenting using real surgery on animal or human,computational simulations(virtual surgery)were performed to test different band combination and insertion options to identify optimal surgery design and band insertion plan.Methods Cardiac magnetic resonance(CMR)data were obtained from one rTOF patient(sex:male,age:22.5 y)before pulmonary valve replacement surgery.The patient was suffering from RV dilation and dysfunction with RV end-systole volume 254.49ml and end-diastole volume 406.91 mL.A total of 15 computational RV/LV/Patch/Band combination models based on(CMR)imaging were constructed to investigate the influence of different band insertion surgery plans.These models included 5 different band insertion models combined and 3 different band contraction ratio(10%,15%and 20%band zero-stress length reduction).These models included 5 different band insertion models:Model 1 with one band at anterior to the middle of papillary muscle;Model 2 with one band at posterior to the middle of papillary muscle;Model 3 with 2 bands which are the ones from Models 1&2 combined;Model 4 with a band at the base of the papillary muscle;Model 5 with 3 bands which is a combination of Models 3&4.A pre-shrink

关键词： Heart model heart failure Tetralogy of fallot Contraction band

Scalp block for brain abscess drainage in a patient with uncorrected tetralogy of fallot

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World Journal of Clinical Cases 2014年第12期2卷 934-937页

作者： Sameer Sethi Sonia Kapil Department of Anesthesia Post Graduate Institute of Medical Education And Research Chandigarh 160012 India

We report a case of an 11-year-old boy with diagnosed but uncorrected tetralogy of fallot presented to us for brain abscess drainage. The child was managed successfully with scalp block with sedation.

关键词： Tetralogy of fallot Brain abscess Ketamine Scalp block Congenital heart disease

Primary Results of Late Surgical Treatment in Children with Tetralogy of fallot from a Developing Country

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World Journal of Cardiovascular Diseases 2019年第8期9卷 538-544页

作者： M. Hofbeck D. A. Affangla A. Hanser L. Sieverding G. Wiegand R. Kaulitz M. Kumpf M. Moustafi F. Neunhoeffer C. Schlensak G. A. Bazolo Ba Ngouala D. M. Ba I. Basse M. Leye Department of Pediatric Cardiology University Hospital of Tübingen Tübingen Germany Faculty of Medicine University of Thiès Thiès Senegal Department of Thoracic and Cardiovascular Surgery University Hospital of Tübingen Tübingen Germany Louga Regional Hospital Louga Senegal

Objectives: The purpose was to show how important is to operate on the Senegalese African children presenting with Tetralogy of fallot (TOF) regardless of their age. Methods: It is a retrospective, descriptive analysis of data from the Department of Pediatric Cardiology, University Hospital of Tuebingen’s data base which was searched for all cases of TOF in foreign patients younger than 15 years between 05/2004-10/2016. Results: 16 children from Senegal with TOF were referred for treatment. Mean age of patients was 7.0 years (range 0.9 - 14.8 years). Primary corrective surgery was performed in 13/16 patients. A primary shunt procedure was required in 3/16 patients. All patients were discharged in good condition with a median 13 postoperative days. We did not register any deaths. All became asymptomatic with pulse oximetry oxygen saturations greater than 95%. The right ventricular outflow tract (RVOT) gradient was less than 30 mmHg in all patients and 2 patients had moderate pulmonary valvular insufficiency. Conclusions: It was still necessary to operate Senegalese children presenting with TOF irrespective of their age.

关键词： Tetralogy of fallot Late Repair Developing Country Non-Governmental Non-Profit Organization

Early and Long Term Outcomes of Corrective Operations for Tetralogy of fallot: An Experience of Two Centers

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World Journal of Cardiovascular Surgery 2014年第11期4卷 186-192页

作者： Srikrishna Sirivella Isaac Gielchinsky Department of Cardiovascular & Thoracic Surgery Newark Beth Israel Medical Center University of Medicine & Dentistry of New Jersey Newark New Jersey USA

Objectives: Pulmonary valve insufficiency and right ventricular dysfunction may contribute to early and late morbidity and mortality after repair of Tetralogy of fallot. Right ventricular dysfunction may be attributed to ventriculotomy incision, especially, when it is combined with a transannular patch as employed in the transventricular repair. Transatrial/transpulmonary approach without ventriculotomy and an attempt to preserve the pulmonary valve has been advocated as a method potentially diminishing such adverse events. The prevalence of associated morbidity and mortality and analysis of the results of various surgical approaches for repair of Tetralogy of fallot formed the basis of this study. Methods: Nine hundred and ninety five patients during 20 yearS period (from 1992 and 2012) with primary diagnosis of Tetralogy of fallot that underwent total repair operations in two medical centers were analyzed. The mean age of the patients was 2.9 ± 6.9 SE, with female/male ratio of 0.25. The mean long follow-up was 94 months ± 112 SD. Results: Repair via ventriculotomy with transannular patch was the most common technique (n = 627, 63%), followed by infundibulotomy without transannular patch (20%) and transatrial/transpulmonary approach without ventriculotomy (15%). The operative and long term mortality were 3.2% and 4.4%;2% and 3.1%;2% and 2.7% respectively. The overall operative and long term mortality for repairs was 2.9% and 3.4%, with high 3.94% and 6.6% respectively for repairs with right ventricular pulmonary valve conduit. There was statistically significant correlation between the type of repair and mortality risk. Use of transannular patch with ventriculotomy was associated with significant increase in overall mortality risk and operative mortality compared with ventriculotomy without transannular patch. [Odds ratio, 2.10;95% confidence interval: 1.29-3.64]. Operations that have been performed before 2000 have resulted in increased operative risk compared with those performed after 2000. [Odds ratio 1.45;

关键词： Ttralogy of fallot Transventricular Repair Transannular Patch Ventriculotomy Transatrial/Transpulmonary Repair

Polytetrafluoroethylene Patch versus Autologous Pericardial Patch for Right Ventricular Outflow Tract Reconstruction in Patients with Tetralogy of fallot

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World Journal of Cardiovascular Surgery 2017年第3期7卷 41-53页

作者： Sachin Talwar Intekhab Alam Vishnubhatla Srreenivas Palleti Rajashekar Sivasubramanian Ramakrishnan Shiv Kumar Choudhary Balram Airan Department of Cardiothoracic and Vascular Surgery All India Institute of Medical Sciences New Delhi India Biostatistics All India Institute of Medical Sciences New Delhi India Cardiology All India Institute of Medical Sciences New Delhi India

Objective: For patients of TOF with pulmonary annular hypoplasia, reconstruction of right ventricular outflow tract (RVOT) often requires a trans annular patch (TAP). The present study aims to compare the outcomes of TOF repair using Polytetrafluoroethylene (PTFE) patch versus autologous glutaraldehyde fixed pericardial patch for RVOT reconstruction. Materials and methods: 103 consecutive patients undergoing TOF repair in whom TAP was required were randomized into two groups: Group I (pericardial patch), Group II (PTFE patch). Postoperative outcomes in terms of postoperative heart rhythm, duration of mechanical ventilation, mediastinal and pleural drainage, length of stay in intensive care unit (ICU) and hospital mortality were assessed. A separate team of cardiologists independently evaluated pre- and post-operative gradients across the RVOT, degree of pulmonary insufficiency, right ventricular systolic function. Results: There were no significant differences between the two groups in terms of the incidence of postoperative arrhythmias, duration of mechanical ventilation, length of intensive care unit or hospital stay. The requirement of inotropes was no different in the PTFE patch group as compared with the pericardial patch group (16.84 ± 7.04 vs. 17.90 ± 6.71, median 19 vs. 20, p = 0.825). The re-exploration rate was higher in the PTFE group as compared with the pericardial patch group (6 vs. 1). Postoperative Echocar-diography revealed no differences in the RV systolic function between the two groups before discharge. Conclusion: In patients undergoing TOF repair, using a PTFE patch yields comparable results. However, the efficacy of PTFE will only be established once;mid-term and long-term results are available.

关键词： Tetralogy of fallot Right Ventricular Outflow Tract Patch Material