All issues > Volume 49(6); 2006

Original Article

Korean J Pediatr. 2006;49(6):635-642. Published online June 15, 2006.

Early and mid-term results of pulmonary valve reconstruction in surgical repair of tetralogy of Fallot; comparison with other techniques of right ventricular outflow reconstruction

Sheng Wen SW Wang¹, Young Seok YS Lee¹, Si Ho SH Kim², Tae Hong TH Kim³, Ji Eun JE Ban⁴, Hyoung Doo HD Lee⁴, Yun Hee YH Chang⁵, Si Chan SC Sung⁵

¹Department of Pediatrics, College of Medicine, Dong-A University, Busan
²Department of Cardiovascular Surgery, College of Medicine, Dong-A University, Busan
³Department of Pediatrics, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan
⁴Department of Pediatrics, College of Medicine, Pusan National University, Busan, Korea
⁵Department of Cardiovascular Surgery, College of Medicine, Pusan National University, Busan, Korea

Correspondence Young Seok YS Lee ,Email: lyspedia@dau.ac.kr

Abstract

Purpose
: The purpose of this study is to determine whether the new pulmonary valve reconstruction technique prevents short-term postoperative pulmonary regurgitation and improves early and mid-term clinical outcome.
Methods
: We reviewed postoperative echocardiographic variables and chest X-ray films from 31 patients who had undergone valve reconstruction(pulmonary valve reconstruction group : PVR) for the repair of TOF between April 2000 and August 2004. We compared the clinical data of these patients with those from 47 patients who had right ventricular outflow tract reconstruction with a monocusp valve(monocusp ventricular outflow patch group : MVOP) and 22 patients who had a transannular patch repair without a monocusp valve(transannular patch group : TAP).
Results
: In the PVR group, 25 patients(81 percent) had trivial or mild pulmonary regurgitation in their early post operative echocardiogram. Only 12 patients(26 percent) in the MVOP group had mild pulmonary regurgitation; and no patient in the TAP group had it. Pulmonary valve function was good in 96 percent of the PVR group, 36 percent of the MVOP group, and none in the TAP group in early post-operative echocardiogram. Follow-up echocardiogram(1, 2, 3, 4 years later) of the MVOP and TAP groups showed moderate pulmonary regurgitation and severely decreased valve function in almost all cases. However, in the PVR group 54 percent(16/28), 50 percent(14/28), 37 percent(9/24), and 31 percent(5/16) of the patients had trivial or mild pulmonary regurgitation 1, 2, 3 and 4 years after operation, respectively. The valve function remained good in 80 percent(24/30), 64 percent(18/28), 57 percent(12/21), and 31 percent(5/16) of the patients 1, 2, 3 and 4 years after operation respectively.
Conclusion
: Pulmonary valve reconstruction is effective in reducing pulmonary regurgitation and right ventricular dilatation in the repair of TOF, even though regurgitation increases with time. Further study is needed to determine long-term results.

Keywords :Tetralogy of Fallot , Pulmonary regurgitation , Pulmonary valve reconstruction