One-Year Follow-up After Tetralogy of Fallot Total Repair Preserving Pulmonary Valve and Avoiding Right Ventriculotomy

• Published in: Circulation Journal 2018/11/24, Vol.82(12), pp.3064-3068
• Main Authors: Kwak, Jae Gun, Kim, Woong-Han, Kim, Eung Re, Lim, Jae Hong, Min, Jooncheol
• Format: Article
• Language: English
• Subjects: Child, Preschool; Congenital heart disease; Echocardiography; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Male; Pediatrics; Pulmonary Valve - diagnostic imaging; Pulmonary Valve - pathology; Pulmonary Valve - physiopathology; Pulmonary Valve - surgery; Pulmonary Valve Insufficiency - diagnostic imaging; Pulmonary Valve Insufficiency - pathology; Pulmonary Valve Insufficiency - physiopathology; Pulmonary Valve Insufficiency - surgery; Pulmonary Valve Stenosis - diagnostic imaging; Pulmonary Valve Stenosis - pathology; Pulmonary Valve Stenosis - physiopathology; Pulmonary Valve Stenosis - surgery; Tetralogy of Fallot; Tetralogy of Fallot - diagnostic imaging; Tetralogy of Fallot - pathology; Tetralogy of Fallot - physiopathology; Tetralogy of Fallot - surgery; Valvular disease
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-18-0690

Background: We reviewed our revised surgical strategy for tetralogy of Fallot (TOF) total correction to minimize early exposure to significant pulmonary regurgitation (PR) and to avoid right ventriculotomy (RV-tomy). Methods and Results: Since February 2016, we have tried to preserve, first, pulmonary valve (PV) function to minimize PR by extensive commissurotomy with annulus saving; and second, RV infundibular function by avoiding RV-tomy. With this strategy, we performed total correction for 50 consecutive patients with TOF until May 2018. We reviewed the early outcomes of 27 of 50 patients who received follow-up for ≥3 months. Mean patient age at operation was 10.2±5.0 months, and mean body weight was 8.8±1.2 kg. The preoperative pressure gradient at the RV outflow tract and the PV z-score were improved at most recent echocardiography from 82.0±7.1 to 26.8±6.4 mmHg, and from −2.35±0.49 to −0.55±0.54, respectively, during 11.1±1.6 months of follow-up after operation. One patient required re-intervention for residual pulmonary stenosis. Twenty-two patients had less than moderate PR (none, 1; trivial, 8; mild, 13), and 5 patients had moderate PR. There was no free or severe PR. Conclusions: At 1-year follow-up, the patients who underwent total TOF correction with our revised surgical strategy had acceptable results in terms of PV function. The preserved PV had a tendency to grow on short-term follow-up.