Early and 1-year outcome and predictors of adverse outcome following monocusp pulmonary valve reconstruction for patients with tetralogy of Fallot: A prospective observational study

• Published in: Annals of pediatric cardiology 2014-01, Vol.7 (1), p.5-12
• Main Authors: Sasikumar, Deepa, Sasidharan, Bijulal, Tharakan, Jaganmohan A, Dharan, Baiju S, Mathew, Thomas, Karunakaran, Jayakumar
• Format: Article
• Language: English
• Subjects: Cardiovascular system; Care and treatment; Congenital heart surgery; Original; Patient outcomes; pulmonary regurgitation; pulmonary stenosis; Surgery; Tetralogy of Fallot
• ISSN: 0974-2069; 0974-5149
• DOI: 10.4103/0974-2069.126538

Repair of tetralogy of Fallot (TOF) with monocusp pulmonary valve reconstruction prevents pulmonary regurgitation (PR) for a variable period. Since postoperative outcome is governed by PR and right ventricular function, we sought to assess the severity of pulmonary regurgitation and right ventricular outflow (RVOT) gradient in the immediate postoperative period and at 1 year and attempted to identify the anatomical substrates responsible for adverse outcomes. The study included 30 patients. Transthoracic echocardiography was performed before surgery, within 5 days of surgery, and 1 year later. Presence and severity of PR, RVOT gradient, and residual branch pulmonary stenosis were assessed. Right ventricular and monocusp valve functions were studied. Median age was 36.5 months (3-444 months). There were no deaths. Pulmonary regurgitation was mild in 18, moderate in 10, and severe in 2 patients immediately following surgery. At 1 year, 10 patients had severe PR and one had significant RVOT gradient. None of the variables like age, presence of supravalvar pulmonary branch stenosis, main pulmonary artery diameter, or mobility of monocusp valve was found to have any significant association with the progression of PR. McGoon index