Intermediate Outcomes of Staged Tetralogy of Fallot Repair

2019 ◽  
Vol 10 (6) ◽  
pp. 694-701 ◽  
Author(s):  
Poonam Mahajan ◽  
Eric S. Ebenroth ◽  
Kirsten Borsheim ◽  
Sabena Husain ◽  
Na Bo ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Tetralogy Of Fallot ◽  
Pulmonary Valve ◽  
Surgical Intervention ◽  
Main Pulmonary Artery ◽  
Postoperative Arrhythmia ◽  
Young Infants ◽  
Intermediate Outcomes ◽  
Valve Annulus ◽  
Early Surgical Intervention

Background: The optimal surgical strategy for tetralogy of Fallot (TOF) repair in neonates and young infants requiring early surgical intervention remains controversial. Our surgical center follows the uniform strategy of a staged approach with initial systemic-to-pulmonary artery shunt the majority of time when early surgical intervention is required. We characterized a contemporary cohort of patients with TOF with pulmonary stenosis (PS) undergoing staged repair in order to determine the rate of pulmonary valve-sparing repair (PVSR), growth of the pulmonary valve annulus and pulmonary arteries, postoperative morbidity and mortality, and need for reintervention. Methods: We retrospectively studied patients with TOF/PS who underwent staged repair from 2000 to 2017. Surgical details, postoperative course, and reinterventions were noted. Echocardiographic measurements and Z-score values of pulmonary valve annulus, main pulmonary artery (MPA), right pulmonary artery (RPA), and left pulmonary artery (LPA) diameters were evaluated. Results: Of the 59 patients with staged TOF/PS, PVSR was performed in 25 (42%). There was a 5% incidence of postoperative arrhythmia. The Z-scores of MPA, RPA, and LPA were significantly higher before complete repair when compared to before palliative shunt. The 5 and 10-year survival rates were both 93%, and the probability of freedom from reoperation at 5 and 10 years was 87% and 82%, respectively. Conclusions: Staged repair of TOF in young symptomatic infants results in 42% receiving PVSR, pulmonary artery growth, low incidence of postoperative arrhythmia, and relatively low rate of reoperations.

Modified Repair of Tetralogy of Fallot with Absent Pulmonary Valve Syndrome

1996 ◽  
Vol 4 (3) ◽  
pp. 178-180
Author(s):  
Jacques AM van Son ◽  
Volkmar Falk ◽  
Friedrich W Mohr
Keyword(s):  
Pulmonary Artery ◽  
Tetralogy Of Fallot ◽  
Pulmonary Valve ◽  
Main Pulmonary Artery ◽  
Pulmonary Arteries ◽  
Absent Pulmonary Valve ◽  
Modified Technique ◽  
Ventricular Compliance ◽  
Critically Ill Neonates ◽  
Absent Pulmonary Valve Syndrome

A modified technique for the repair of tetralogy of Fallot with absent pulmonary valve syndrome and stenosis at the origin of the lobar or segmental pulmonary artery branches is described. This consists of generous reduction plasty of the redundant anterior and posterior walls of the aneurysmally dilated branches of the pulmonary artery, resection of the main pulmonary artery, pericardial patch augmentation of the stenotic origins of the lobar or segmental pulmonary artery branches, insertion of a valved pulmonary allograft, and closure of the ventricular septal defect. The advantages of this technique, in addition to relief of the left-to-right shunt, consist of complete decompression of the tracheobronchial structures, and restoration of the capacitance of the central pulmonary arteries. This may result in a reduced tendency for postoperative respiratory insufficiency as well as long-term preservation of right ventricular compliance. The technique was successfully performed on 2 critically ill neonates and a 3-month-old infant.

scholarly journals Fungal infective endocarditis of polytetrafluoroethylene pulmonary valve with Paecilomyces species following tetralogy of Fallot correction

2020 ◽  
Vol 7 (5) ◽  
pp. 1666
Author(s):  
Sumeet Anand ◽  
Swaminathan Vaidyanathan ◽  
Mustafa Janeel ◽  
Neville A. G. Solomon
Keyword(s):  
Infective Endocarditis ◽  
Early Diagnosis ◽  
Tetralogy Of Fallot ◽  
Laboratory Tests ◽  
Pulmonary Valve ◽  
Surgical Intervention ◽  
Immunocompromised Host ◽  
Bacterial Endocarditis ◽  
High Index Of Suspicion ◽  
Early Surgical Intervention

Fungal infective endocarditis of the prosthetic pulmonary valve in non immunocompromised host is growing phenomena attributed to the increased use of prosthetic materials. High mortality and neurovascular sequalae is commonly seen in such case if treatment is delayed. Often misdiagnosed as bacterial endocarditis due to closely resembling clinical features and lack of inexpensive and readily available laboratory tests, the diagnosis is often delayed. High index of suspicion and early surgical intervention is needed for early diagnosis and management

P268 Anomalies of pulmonary arteries in Tetralogy of Fallot in developing countries: study of 100 cases in indian population

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
A Tiwari ◽  
PARAG Barwad ◽  
U M A Dabi
Keyword(s):  
Pulmonary Artery ◽  
Aortic Arch ◽  
Tetralogy Of Fallot ◽  
Surgical Management ◽  
Pulmonary Valve ◽  
Pulmonary Stenosis ◽  
Main Pulmonary Artery ◽  
Pulmonary Arteries ◽  
Great Vessels ◽  
Pulmonary Artery Abnormalities

Abstract Introduction Right ventricular outflow tract (RVOT) obstruction in some or other form is one of the major components of Tetralogy of Fallot. It can occur at any level, isolated or in combination, from Infundibulum (most common), Pulmonary valve, Main pulmonary artery, Right and Left pulmonary arteries and up to their segmental branches. Incidence of pulmonary artery anomalies are reported between 15-20%, though some reported as high as 40%.  Purpose  The objective of this retrospective  observational study is to determine the presence and degree of pulmonary artery  abnormalities and associated cardiac defects in patients with Tetralogy of Fallot and to  define the pulmonary arterial anatomy to guide the further surgical management. Method A total of 100 newly diagnosed or follow up cases of TOF irrespective of age (range 5 days- 32 years) and gender (32 female, 68 male) who were planned for surgical management and referred for evaluation of pulmonary artery anatomy. All patient underwent non-ECG gated CT pulmonary Angiography in Toshiba 64 slice CT scanner.  CT data was analyzed retrospectively to look for cardiac and pulmonary artery anatomy by one independent observer having experience in cardiac radiology. Results 92 patient had infundibular and valvular stenosis and 8 patients has atretic pulmonary valve with additional supravalvar pulmonary stenosis in 17% patient. Out of total 100 patients, 35% had pulmonary artery abnormalities. This included 19 patient (19%) with isolated main pulmonary artery (MPA) abnormality, 6 % had isolated left pulmonary artery (LPA) abnormality, 2 had isolated right pulmonary artery abnormality, 4% had  combined MPA and LPA  abnormality, 2% had combined MPA and RPA abnormalities and 1% patient had all 3 (MPA,LPA,RPA) involvement in form of stenosis or hypoplasia. As TOF is commonly associated with other cardiac structural anomalies, we encountered following associations in our study – aortopulmonary collaterals (37%), Patent ductus arteriosus (29%), right sided aortic arch (19%), bilateral superior vena cava (10%), bovine arch (3%), double aortic arch (2%), d malposition of great vessels (2%), l malposition of great vessels (1%), situs inversus (1%), dextrocardia (1%), annuloaortic ectasia (1%) aortopulmonary window (1%) and cardiac totally anomalous pulmonary venous connection (1%). Conclusions Anomalies of pulmonary arteries are important determinant of surgical outcome of TOF patients. CT angiography is now established modality to delineate pulmonary artery and other anatomical details in TOF patient. Pulmonary artery anomaly can range from isolated branch pulmonary stenosis to diffuse hypoplasia of pulmonary vasculature, based on which management can differ from complete correction to palliative or medical management only. Our study emphasize the importance of pulmonary artery evaluation and its variation among patients of TOF. Abstract P268 Figure.

Evolving Techniques for the Achievement of Optimal Long-Term Results After Tetralogy of Fallot Repair

2021 ◽  
Vol 12 (1) ◽  
pp. 116-123
Author(s):  
Giovanni Stellin ◽  
Alvise Guariento ◽  
Vladimiro L. Vida
Keyword(s):  
Tetralogy Of Fallot ◽  
Balloon Dilatation ◽  
Pulmonary Valve ◽  
Long Term Results ◽  
Complex Congenital Heart Disease ◽  
Valve Reconstruction ◽  
Valve Annulus ◽  
Teaching Cases ◽  
Tetralogy Of Fallot Repair

Several techniques designed to improve long-term results after repair of tetralogy of Fallot are described. We have recently embarked on a program focused on preserving the native pulmonary valve. Here, combined techniques are described in detail, including intraoperative pulmonary valve balloon dilatation, pulmonary valve reconstruction by delamination and resuspension of the leaflets, and pulmonary valve annulus augmentation. As with any other complex congenital heart disease, senior surgeons should select teaching cases, starting from the less severe side of the spectrum.

scholarly journals Pulmonary Valve Insufficiency as a Complication of Radical Surgical Treatment of Tetralogy of Fallot

2017 ◽  
Vol 34 (2) ◽  
pp. 179-188
Author(s):  
Milovan Stojanović ◽  
Marina Deljanin-Ilić ◽  
Aleksa Vuković ◽  
Dejan Petrović
Keyword(s):  
Surgical Treatment ◽  
Tetralogy Of Fallot ◽  
Pulmonary Valve ◽  
Surgical Intervention ◽  
Ultrasound Examination ◽  
Clinical Signs ◽  
Common Complication ◽  
Pulmonary Valve Insufficiency ◽  
Valve Insufficiency ◽  
Additional Imaging

Summary Tetralogy of Fallot is the most common cyanogenic congenital heart defect. The diagnosis is based on clinical signs, ECG examination, ultrasound examination of the heart, additional imaging methods and invasive testing. The therapeutic approach to the patient with tetralogy is complex and based on conservative and radical methods. Patients who have not undergone a radical surgical intervention have a poor prognosis, whereas the prognosis is much better for patients who have been operated. The most common complication of the surgical treatment is the pulmonary valve insufficiency which usually requires reintervention, as was the case with our patient.

scholarly journals Isolated Pulmonary Infective Endocarditis with Septic Pulmonary Embolism Complicating a Right Ventricular Outflow Tract Obstruction: Scarce and Devious Presentation

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Abdelrahmen Abdelbar ◽  
Raed Azzam ◽  
Kok Hooi Yap ◽  
Ahmed Abousteit
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Pulmonary Valve ◽  
Main Pulmonary Artery ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Diagnostic Tools ◽  
Septic Pulmonary Embolism

We present a case of a fifty-three-year-old male who presented with severe sepsis. He had been treated as a pneumonia patient for five months before the admission. Investigations revealed isolated pulmonary valve endocarditis and septic pulmonary embolism in addition to undiagnosed right ventricular outflow tract (RVOT) obstruction. The patient underwent surgery for the relief of RVOT obstruction by substantial muscle resection of the RVOT, pulmonary artery embolectomy, pulmonary valve replacement, and reconstruction of RVOT and main pulmonary artery with two separate bovine pericardial patches. He was discharged from our hospital after 6 weeks of intravenous antibiotics. He recovered well on follow-up 16 weeks after discharge. A high-suspicion index is needed to diagnose right-side heart endocarditis. Blood cultures and transesophageal echocardiogram are the key diagnostic tools.

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