Cardiac Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran.
Shiraz University of Medical Sciences, Shiraz, Iran.
Eur J Cardiothorac Surg. 2021 Apr 13;59(3):697-704. doi: 10.1093/ejcts/ezaa374.
The prevention of pulmonary insufficiency (PI) is a crucial part of the tetralogy of Fallot repair. Many techniques have been introduced to construct valves from different materials for the right ventricular outflow tract, including the most commonly constructed monocusp valves. We are introducing a new bicuspid valve made intraoperatively using the autologous right atrial appendage (RAA) to prevent PI in these patients.
The RAA valve was constructed and used in 21 patients with tetralogy of Fallot. The effective preservation of the native valve was impossible in all patients because of either a severe valve deformity or a small annulus. The RAA valve was created after ventricular septal defect closure and right ventricular outflow tract myectomy and was covered with a bovine transannular pericardial patch. The perioperative data were evaluated, and the echocardiography results were assessed immediately after operations and in follow-up with a median of 10.5 months. The data were retrospectively compared with 10 other patients with similar demographic data but with only transannular patches.
The mean age of the patients was 13.3 months. No mortality or related morbidity occurred after repair using the RAA valve. The PI severity early after the operation was trivial or no PI in 18 patients, and mild PI was observed in 3 patients, which progressed to moderate PI in one of them in the mean 12-month follow-up period. Fifteen patients had mild or no pulmonary stenosis, while moderate pulmonary stenosis was observed in 6 others. Compared with the other 10 patients with only transannular patches, the RAA valve patients had prolonged operative and clamping times, but no difference in postoperative course and shorter hospital stays. The degree of PI was, of course, significantly less in the RAA valve patients, but pulmonary stenosis was the same.
The RAA valve construction is a safe and effective technique to prevent PI after the tetralogy of Fallot repair, at least in terms of short- and mid-term results. A longer follow-up period is needed to confirm if this new valve can eliminate or significantly delay the need for pulmonary valve replacement in these patients.
预防肺功能不全（PI）是法洛四联症修复的关键部分。许多技术已被引入到右心室流出道的不同材料的构建中，包括最常构建的单瓣。我们正在引入一种新的二叶瓣，通过使用自体右心房附件（RAA）在这些患者中构建，以预防 PI。
在 21 例法洛四联症患者中构建并使用 RAA 瓣。由于严重的瓣膜畸形或小瓣环，所有患者都无法有效保留原生瓣膜。RAA 瓣在室间隔缺损闭合和右心室流出道心肌切除后构建，并覆盖牛颈静脉环心包补片。评估围手术期数据，并在手术后和中位随访 10.5 个月时评估超声心动图结果。将数据与 10 例具有类似人口统计学数据但仅使用颈静脉环补片的其他患者进行回顾性比较。
患者的平均年龄为 13.3 个月。使用 RAA 瓣修复后无死亡或相关并发症。18 例患者术后早期 PI 严重程度为轻度或无 PI，3 例患者观察到轻度 PI，其中 1 例在平均 12 个月随访期间进展为中度 PI。15 例患者有轻度或无肺动脉瓣狭窄，而另外 6 例患者有中度肺动脉瓣狭窄。与仅使用颈静脉环补片的 10 例患者相比，RAA 瓣患者的手术和夹闭时间延长，但术后病程和住院时间较短。RAA 瓣患者的 PI 程度当然较轻，但肺动脉瓣狭窄程度相同。
RAA 瓣构建是预防法洛四联症修复后 PI 的一种安全有效的技术，至少在短期和中期结果方面。需要更长的随访时间来确认这种新瓣膜是否可以消除或显著延迟这些患者对肺动脉瓣置换的需求。
