The Experience Of Right Ventricular Outflow Reconstruction Of Tetralogy Of Fallot In Infants

Background Tetralogy of Fallot (TOF) remains one of the most common cyanotic congenital heart diseases and complete repair is the choice of surgical correction. In patients with severe stenosis of the pulmonary annulus,in addition to the muscular stenosis at the right ventricular outflow tract (RVOT), transannular repair may be inevitable but may lead to pulmonary insufficiency featured by pulmonary regurgitation. It has, for a long time,been recognized that long-standing pulmonary insuffi-ciency after repair of TOF may adversely affect ventricular function,and even in the modern era, pulmonary insufficiency remains a problem, particularly for late results.Recently, pulmonary regurgitation is reported to develop in up to 30% of patients at a follow-up of 20 years and results in progressive right ventricular (RV) dilatation and dysfunction in an increasing number of patients.Further, transannular patch correlates with poor late outcome or increased reoperation rates.It was estimated that 10% to 15% or more of those who had significant pulmonary insufficiency at 20 years after operation need pulmonary valve replacement.Homograft valve insertion for pulmonary regurgitation late after valveless repair of RVOT obstruction was also reported.To eliminate the postoperative pulmonary insuffi-ciency, there are two strategies. First, in the patient population with muscular RVOT stenosis but normal or subnormal size of the pulmonary artery annulus, avoidance of the transannular patch-repair may be the best choice. Even in early repair of TOF or in the presence of anomalous coronary arteries, this may be feasible. Resection of the muscular bands in the RVOT with or without mild dilatation of the pulmonary artery annulus can result in adequate size of the RVOT-pulmonary artery, without creating significant pulmonary insufficiency. However, there are a number of patients whose pulmonary artery annulus is extremely underdeveloped, and therefore, transannular patch-repair becomes absolutely necessary. The second strategy to reduce the postoperative pulmonary insufficiency is to create a valve in the pulmonary position when transannular repair is inevitable. Different methods have been used to create a valve in the pulmonary artery annulus to resume the pulmonary valvular function.Objectives The purpose of the present study was1. To summarize clinical therapy experience of right ventricular outflow reconstruction of Tetralogy of Fallot in 40 infants.2. To evaluate the effect of the new right ventricular outflow reconstruction in Tetralogy of Fallot patients.Subjects and MethodsFrom Jun 2004 to Dec 2009,40 Tetralogy of Fallot infants had underwent primary correction in our department, and were completely random designed into two groups (including ameliorated manual pericardial patch with valve group and traditional pericardial patch with valve group) to proceed different procedure of right ventricular outflow reconstruction respectively. Regurgitation of pulmonary valve and heart function had been analyzed by investigating the major clinical index and assistant examine index from echocardiography on the periods of before and after the operation.ResultsThe operations of two groups were success. The analysis on the index of right ventricular function between two groups after operation exited marked contrastive difference with P<0.05, and the end dilation volume index of right ventricle, on the periods of one month and six months after operation, was respectively 16.25±0.39,16.36±0.43 in testing group and 16.93±0.37,16.98±0.30 in comparing group else; the area of pulmonary valve regurgitation was 1.24±0.14 cm2,1.36±0.41 cm2 in testing group and was 1.80±0.43cm2,2.24±0.49 cm2 in comparing group at the same time.ConclusionsIt is available to use 0.1mm Gore-tex manual pericardial patch as pulmonary valve in the right ventricular outflow reconstruction of Tetralogy of Fallot in infants.