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Pulmonary Valve-Sparing Surgery in Tetralogy of Fallot: Early Results of Pulmonary Flow Hemodynamics

Year 2020, Volume: 23 Issue: 2, 134 - 140, 16.08.2020

Abstract

Introduction: Tetralogy of Fallot is the most common form of cyanotic congenital heart disease. We aimed to share our experience of pulmonary annulus preserving surgery as the current and increasingly preferred treatment option in this study.

Patients and Methods: In this study, the data of 30 pediatric patients who underwent corrective repair by preserving the pulmonary valve annulus were evaluated retrospectively. Demographic data, angiographic, and echocardiographic findings before and after surgery were recorded.

Results: In our study, 20 (66.7%) patients were male, 10 (33.3%) were female; median age of the patients was 29 months. In the preoperative evaluation, 16 patients had a pulmonary valve with two leaflets (53.3%), and 14 patients had three leaflets (46.7%). McGoon indexes calculated as mean 1.82 ± 0.23 by echocardiography and 2 ± 0.29 by angiography. Pulmonary valve annulus Z-scores were determined as mean -1.8 ± 1.1 echocardiographically and -0.9 ± 1.2 angiographically. Mean right ventricle systolic pressures measured in echocardiographic examination at 1st, 7th, and 14th days after surgery were 42.3 ± 6.5, 38.7 ± 4.9, and 35.8 ± 4.9 mmHg, respectively, and decreasing values were significant statistically. Pulmonary valve pressure gradients measured at postoperative 1st, 7th, and 14th days and found as mean 27.2 ± 5.6, 25.5 ± 6.2, and 24.4 ± 6.2 mmHg, respectively; this decrease was also statistically significant. There was no mortality or significant morbidity during the mean 7.97 ± 3.39 months follow-up period.

Conclusion: Preservation of pulmonary valve during surgery is an effective treatment option in the treatment of tetralogy of Fallot in terms of reducing early and late complications and should become a more prevalent technique.

References

  • 1. Owen AR, Gatzoulis MA. Tetralogy of fallot: late outcome after repair and surgical implications. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2000;3:216-26.
  • 2. Dawoud MA, Abd Al Jawad MN, Hikal T, Samir K. Single-stage complete repair versus multistage repair of tetralogy of fallot with borderline pulmonary arteries. Heart Surg Forum 2018;21:E466-71.
  • 3. Kaulitz R, Jux C, Bertram H, Paul T, Ziemer G, Hausdorf G. Primary repair of tetralogy of Fallot in infancy-the effect on growth of the pulmonary arteries and the risk for late reinterventions. Cardiol Young 2001;11:391-8.
  • 4. Hofferberth SC, Nathan M, Marx GR, Lu M, Sleeper LA, Marshall AC, et al. Valve-sparing repair with intraoperative balloon dilation in tetralogy of Fallot: Midterm results and therapeutic implications. J Thorac Cardiovasc Surg 2018;155:1163-73.
  • 5. Mavroudis C, Mavroudis CD, Frost J. Pulmonary valve preservation and restoration strategies for repair of tetralogy of Fallot. Cardiol Young 2014;24:1088-94.
  • 6. Türköz R, Doğan A, Oktay A, Saygılı A. Valve-sparing repair with skeletonization of the pulmonary annulus for tetralogy of Fallot. J Card Surg 2019;34:1626-8.
  • 7. Kim H, Sung SC, Kim SH, Chang YH, Lee HD, Park JA, et al. Early and late outcomes of total repair of tetralogy of Fallot: Risk factors for late right ventricular dilatation. Interact Cardiovasc Thorac Surg 2013;17:956-62.
  • 8. Arafat AA, Elatafy EE, Elshedoudy S, Zalat M, Abdallah N, Elmahrouk A. Surgical strategies protecting against right ventricular dilatation following tetralogy of Fallot repair. J Cardiothorac Surg 2018;13:1-7.
  • 9. Ducas RA, Harris L, Labos C, Kumar Nair GK, Wald RM, Hickey EJ, et al. Outcomes in young adults with tetralogy of fallot and pulmonary annular preserving or transannular patch repairs. Can J Cardiol 2020;S0828-282X(20)30399-8.
  • 10. Padalino MA, Pradegan N, Azzolina D, Galletti L, Pace Napoleone C, Agati S, et al. The role of primary surgical repair technique on late outcomes of Tetralogy of Fallot: A multicentre study. Eur J Cardiothoracic Surg 2020;57:565-73.
  • 11. Lozano-Balseiro M, Garcia-Vieites M, Martinez-Bendayan I, Garcia-Hernandez I, Cuenca-Castillo JJ, Rueda-Nunez F, et al. Valve-sparing tetralogy of fallot repair with intraoperative dilation of the pulmonary valve. Mid-Term Results. Semin Thorac Cardiovasc Surg 2019;31:828-34.
  • 12. Awori MN, Mehta NP, Mitema FO, Kebba N. Optimal use of Z-scores to preserve the pulmonary valve annulus during repair of tetralogy of fallot. World J Pediatr Congenit Heart Surg 2018;9:285-8.
  • 13. Jonas RA. Early primary repair of tetralogy of fallot. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2009;12:39-47.
  • 14. Stewart RD, Backer CL, Young L, Mavroudis C. Tetralogy of fallot: results of a pulmonary valve-sparing strategy. Ann Thorac Surg 2005;80:1431-9.
  • 15. Kasturi S, Balaji S, Sudhakar A, Sunil GS, Kottayil BP, Bayya PR, et al. Accuracy of a new echocardiographic index to predict need for transannular patch in tetralogy of fallot. Pediatr Cardiol 2019;40:161-7.
  • 16. Choi SJ, Kwon JE, Roh DE, Hyun MC, Jung HN, Lee YO, et al. Importance of pulmonary valve morphology for pulmonary valve preservation in tetralogy of Fallot surgery: comparison of the echocardiographic parameters. Clin Exp Pediatr 2020;63:189-94.
  • 17. Hickey E, Pham-Hung E, Halvorsen F, Gritti M, Duong A, Wilder T, et al. Annulus-sparing tetralogy of fallot repair: low risk and benefits to right ventricular geometry. Ann Thorac Surg 2018;106:822-9.
  • 18. Antunes M, Castela E, Sanches M, Melo A. Preservation of the pulmonary annulus in total correction of tetralogy of Fallot *1Decreasing transannular gradients in the early follow-up period. Eur J Cardiothoracic Surg 1991;5:528-33.
  • 19. Yoo BW, Kim JO, Kim YJ, Choi JY, Park HK, Park YH, et al. Impact of pressure load caused by right ventricular outflow tract obstruction on right ventricular volume overload in patients with repaired tetralogy of Fallot. J Thorac Cardiovasc Surg 2012;143:1299-304.

Fallot Tetralojisi Cerrahisinde Pulmoner Kapak Koruma: Pulmoner Akım Hemodinamikleri Erken Dönem Sonuçları

Year 2020, Volume: 23 Issue: 2, 134 - 140, 16.08.2020

Abstract

Giriş: Fallot tetralojisi en sık görülen siyanotik doğuştan kalp hastalığıdır. Çalışmada hastalığın güncel ve giderek daha çok tercih edilen tedavi seçeneği olarak pulmoner anülüs koruyucu cerrahi deneyimlerin paylaşılması ve literatüre katkı sağlanması amaçlanmıştır.

Hastalar ve Yöntem: Çocuk kalp damar cerrahisi kliniğinde pulmoner kapak anülüsü korunarak cerrahi tam düzeltici onarım yapılan 30 çocuk hastanın verileri retrospektif olarak değerlendirildi. Hastaların demografik verileri, operasyon öncesi ekokardiyografi ve anjiyografi bulguları ve sonrasında tekrarlanan ekokardiyografi bulguları kaydedildi.

Bulgular: Olguların 20 (%66.7)’si erkek, 10 (%33.3)’u kız; hasta ortanca yaşı 29 ay (10-212 ay) idi. İntraoperatif değerlendirmede 16 hastanın pulmoner kapak yapısının 2 (%53.3) yaprakcıklı, 14 hastanın ise 3 (%46.7) yaprakcıklı olduğu görülmüştür. McGoon indeksleri ekokardiyografi ile ortalama 1.82 ± 0.23; anjiyografik olarak ortalama 2 ± 0.29 olarak hesaplanmıştır. Pulmoner kapak anülüs Z skorları ekokardiyografi ile ortalama -1.8 ± 1.1; anjiyografik olarak ortalama -0.9 ± 1.2 saptanmıştır. Postoperatif 1, 7 ve 14. günlerde ekokardiyografi ile sağ ventrikül sistolik basınç ortalamaları sırasıyla 42.3 ± 6.5 mmHg, 38.7 ± 4.9 mmHg ve 35.8 ± 4.9 mmHg olarak ölçülmüş ve değerler arasında istatistiksel olarak anlamlı bir azalma tespit edilmiştir. Eşzamanlı bakılan pulmoner kapak gradientleri sırasıyla 27.2 ± 5.6 mmHg; 25.5 ± 6.2; 24.4 ± 6.2 mmHg saptanmış ve istatistiksel olarak anlamlı olarak düşüş olduğu görülmüştür. Ortalama 7.97 ± 3.39 ay takip süresince mortalite ve ciddi morbidite gözlenmemiştir.

Sonuç: Fallot tetralojisi tedavisinde cerrahi sırasında pulmoner kapağın korunması erken ve geç dönem komplikasyonların azaltılması bakımından etkili bir tedavi seçeneğidir.

References

  • 1. Owen AR, Gatzoulis MA. Tetralogy of fallot: late outcome after repair and surgical implications. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2000;3:216-26.
  • 2. Dawoud MA, Abd Al Jawad MN, Hikal T, Samir K. Single-stage complete repair versus multistage repair of tetralogy of fallot with borderline pulmonary arteries. Heart Surg Forum 2018;21:E466-71.
  • 3. Kaulitz R, Jux C, Bertram H, Paul T, Ziemer G, Hausdorf G. Primary repair of tetralogy of Fallot in infancy-the effect on growth of the pulmonary arteries and the risk for late reinterventions. Cardiol Young 2001;11:391-8.
  • 4. Hofferberth SC, Nathan M, Marx GR, Lu M, Sleeper LA, Marshall AC, et al. Valve-sparing repair with intraoperative balloon dilation in tetralogy of Fallot: Midterm results and therapeutic implications. J Thorac Cardiovasc Surg 2018;155:1163-73.
  • 5. Mavroudis C, Mavroudis CD, Frost J. Pulmonary valve preservation and restoration strategies for repair of tetralogy of Fallot. Cardiol Young 2014;24:1088-94.
  • 6. Türköz R, Doğan A, Oktay A, Saygılı A. Valve-sparing repair with skeletonization of the pulmonary annulus for tetralogy of Fallot. J Card Surg 2019;34:1626-8.
  • 7. Kim H, Sung SC, Kim SH, Chang YH, Lee HD, Park JA, et al. Early and late outcomes of total repair of tetralogy of Fallot: Risk factors for late right ventricular dilatation. Interact Cardiovasc Thorac Surg 2013;17:956-62.
  • 8. Arafat AA, Elatafy EE, Elshedoudy S, Zalat M, Abdallah N, Elmahrouk A. Surgical strategies protecting against right ventricular dilatation following tetralogy of Fallot repair. J Cardiothorac Surg 2018;13:1-7.
  • 9. Ducas RA, Harris L, Labos C, Kumar Nair GK, Wald RM, Hickey EJ, et al. Outcomes in young adults with tetralogy of fallot and pulmonary annular preserving or transannular patch repairs. Can J Cardiol 2020;S0828-282X(20)30399-8.
  • 10. Padalino MA, Pradegan N, Azzolina D, Galletti L, Pace Napoleone C, Agati S, et al. The role of primary surgical repair technique on late outcomes of Tetralogy of Fallot: A multicentre study. Eur J Cardiothoracic Surg 2020;57:565-73.
  • 11. Lozano-Balseiro M, Garcia-Vieites M, Martinez-Bendayan I, Garcia-Hernandez I, Cuenca-Castillo JJ, Rueda-Nunez F, et al. Valve-sparing tetralogy of fallot repair with intraoperative dilation of the pulmonary valve. Mid-Term Results. Semin Thorac Cardiovasc Surg 2019;31:828-34.
  • 12. Awori MN, Mehta NP, Mitema FO, Kebba N. Optimal use of Z-scores to preserve the pulmonary valve annulus during repair of tetralogy of fallot. World J Pediatr Congenit Heart Surg 2018;9:285-8.
  • 13. Jonas RA. Early primary repair of tetralogy of fallot. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2009;12:39-47.
  • 14. Stewart RD, Backer CL, Young L, Mavroudis C. Tetralogy of fallot: results of a pulmonary valve-sparing strategy. Ann Thorac Surg 2005;80:1431-9.
  • 15. Kasturi S, Balaji S, Sudhakar A, Sunil GS, Kottayil BP, Bayya PR, et al. Accuracy of a new echocardiographic index to predict need for transannular patch in tetralogy of fallot. Pediatr Cardiol 2019;40:161-7.
  • 16. Choi SJ, Kwon JE, Roh DE, Hyun MC, Jung HN, Lee YO, et al. Importance of pulmonary valve morphology for pulmonary valve preservation in tetralogy of Fallot surgery: comparison of the echocardiographic parameters. Clin Exp Pediatr 2020;63:189-94.
  • 17. Hickey E, Pham-Hung E, Halvorsen F, Gritti M, Duong A, Wilder T, et al. Annulus-sparing tetralogy of fallot repair: low risk and benefits to right ventricular geometry. Ann Thorac Surg 2018;106:822-9.
  • 18. Antunes M, Castela E, Sanches M, Melo A. Preservation of the pulmonary annulus in total correction of tetralogy of Fallot *1Decreasing transannular gradients in the early follow-up period. Eur J Cardiothoracic Surg 1991;5:528-33.
  • 19. Yoo BW, Kim JO, Kim YJ, Choi JY, Park HK, Park YH, et al. Impact of pressure load caused by right ventricular outflow tract obstruction on right ventricular volume overload in patients with repaired tetralogy of Fallot. J Thorac Cardiovasc Surg 2012;143:1299-304.
There are 19 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Investigations
Authors

Özgür Yıldırım This is me 0000-0002-6842-135X

İsmail Balaban This is me 0000-0001-9424-9760

Publication Date August 16, 2020
Published in Issue Year 2020 Volume: 23 Issue: 2

Cite

Vancouver Yıldırım Ö, Balaban İ. Pulmonary Valve-Sparing Surgery in Tetralogy of Fallot: Early Results of Pulmonary Flow Hemodynamics. Koşuyolu Heart Journal. 2020;23(2):134-40.