ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
The Effect of Right Ventricle Outflow Tract Reconstruction Methods on Right Ventricular Function in Tetralogy of Fallot
Süleyman Özkan 1, Tankut Akay 1, Bahadır Gültekin 1, Ahmet Aslan 1, Birgül Varan 2, Kürşat Tokel 2, Sait Aşlamacı1
1Başkent Üniversitesi Tıp Fakültesi Hastanesi, Kalp ve Damar Cerrahisi Anabilim Dalı, Ankara
2 Başkent Üniversitesi Tıp Fakültesi Hastanesi, Pediatrik Kardiyoloji Anabilim Dalı, Ankara
Background: We evaluated long-term right ventricular dysfunction following total repair of tetralogy of Fallot (TOF) using a transannular or infundibular patch.

Methods: The study included 39 patients (mean age 12.1±3.1 years; range 8 to 21 years) who were operated on between 1983 and 1996, and had a follow-up of at least five years. Reconstruction of the right ventricle outflow tract was performed with a transannular and infundibular patch in 26 and 13 patients, respectively. The patients were assessed by telecardiography, echocardiography, and treadmill exercise. The mean follow-up was 7.1±2.1 years (range 5 to 13 years).

Results: Pulmonary valve insufficiency was significantly more common in the transannular patch group (p=0.037). Residual pulmonary gradient was lower than 20 mmHg in all the patients, with no significant difference (p=0.63). In the early postoperative period, it was found that decreases in ventricular pressure ratios were correlated with decreases in the pulmonary gradient. Right ventricle end-diastolic diameters and volumes, stroke volumes, and volume indexes were significantly higher in the transannular patch group, showing dysfunction (p<0.05). In treadmill exercise, all the patients but one in the transannular patch group have performed a mean of 10 metabolic equivalents (METS). Reoperation was planned for one patient in the transannular patch group because of pulmonary valve insufficiency.

Conclusion: Our results suggest that transannular repair with an excessive large patch without considering the ideal diameter is associated with pulmonary valve insufficiency and right ventricular dysfunction.

Keywords : Heart ventricles; pulmonary valve/surgery; pulmonary valve insufficiency/surgery; pulmonary valve stenosis/surgery; tetralogy of Fallot/surgery
Viewed : 16735
Downloaded : 1896