Early Outcomes after Total Correction with Pulmonary Valve and Right Ventricle Preservation Strategy in Tetralogy of Fallot Patients

Jae gun Kwak, Woong-Han Kim

Seoul National University Hospital, Seoul, Korea (South)

Date, time and location: 2018.05.25 15:30, Press Hall, 2F

Abstract

Background

Our hypothesis is that early exposure to significant pulmonary regurgitation (PR) and right ventricle (RV) incision would be more harmful than residual pulmonary stenosis (PS) for the RV function in tetralogy of Fallot (TOF) patient.

Patients and Methods

From February 2016 to December 2017, we changed our surgical strategy for total correction of TOF as follows, regardless of the size of pulmonary annulus if the size of pulmonary arteries was tolerable for total correction; 1. Preserve the pulmonary valvular function to minimize PR by extensive commissurotomy with annulus saving; 2. Preserve RV infundibular function by avoidance of RV incision (non-transannular RV outflow tract widening). With this strategy, we performed total correction for 36 consecutive patients with TOF during study period. We reviewed early outcomes of 20 of 36 patients who had follow-up

Results

Patients’ mean age at the time of operation was 8.5±4.9 months (range:2.5~44.9 months), body weight was 8.4 ± 1.2 kg (range:6.2~17.1 kg), body surface area was 0.40±0.04 (range:0.33~0.70), respectively. The preoperative pressure gradient at right ventricular outflow tract and the z-score of PV were improved at the time of latest echocardiographic examination from 81.8±7.6 to 26.9±8.1 mmHg, and from -2.46±0.54 to -0.62±0.68 after operation during 11.4±2.0 months of follow-up. Only 1 case required re-intervention for residual pulmonary valvular stenosis. Sixteen patients showed trivial (7) or mild (9) degree of PR and 4 patients showed moderate degree of PR.

Conclusions

One year of follow-up results of the patients who underwent total correction of TOF with our aggressively revised surgical strategy were acceptable in the aspects of pulmonary valvular function. Preserved pulmonary valve showed tolerable function and tendency of growing in short-term follow-up. We need long-term follow-up results for these patients’ RV function as well as pulmonary valvular function.