Jain Anil, Rajan Suresh Kumar, Patel Kartik, Garg Pankaj, Agrawal Vishal, Kakkar Deepti, Gajjar Trushar, Mishra Amit, Patel Sanjay, Doshi Chirag
Department of Cardio Vascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India.
Department of Pediatric Cardiac Surgery, U.N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India.
Ann Pediatr Cardiol. 2021 Jul-Sep;14(3):323-330. doi: 10.4103/apc.APC_125_20. Epub 2021 Aug 12.
Adult patients undergoing tetralogy of Fallot (TOF) repair have a higher risk of mortality compared to pediatric patients. Pulmonary regurgitation (PR) further predisposes these patients to heart failure, arrhythmias, and sudden death. Pulmonary valve replacement (PVR) may improve the symptoms in these patients but, fails to reverse the other deleterious effects. Aim of our study was to evaluate the effect of concomitant PVR with TOF repair on right ventricular (RV) parameters, cardiopulmonary exercise capacity, and bioprosthetic valve durability at mid-term.
Between January 2013 and August 2018, 37 adolescents and adults with TOF who had hypoplastic pulmonary annulus underwent concomitant TOF repair with PVR at our institute. We retrospectively collected the data from the hospital records including follow-up.
Mean age of the patients was 18.48 ± 7.53 years. Bioprosthetic valve size ranged from 19 mm to 25 mm. There was no early or late mortality. No patient had developed significant perioperative complications. At a mean follow-up of 53.3 ± 16.4 months, there was no significant change in mean QRS duration, RV function, RV end-systolic and end-diastolic dimensions, RV myocardial performance index, and functional status (including NYHA class and 6-min walk test) compared to at-discharge values. Four patients developed prosthetic valve degeneration with mild PR and without significant increase in gradient.
Concomitant PVR with TOF repair in adult provides excellent mid-term outcome, with a minimal rate of pulmonary valve degeneration. It not only eases the early postoperative course but also preserves the RV function as well as functional status at mid-term.
与小儿患者相比，接受法洛四联症（TOF）修复术的成年患者死亡风险更高。肺动脉反流（PR）使这些患者更容易发生心力衰竭、心律失常和猝死。肺动脉瓣置换术（PVR）可能改善这些患者的症状，但无法逆转其他有害影响。我们研究的目的是评估同期PVR与TOF修复术对中期右心室（RV）参数、心肺运动能力和生物瓣膜耐久性的影响。
2013年1月至2018年8月期间，37例患有肺动脉瓣环发育不良的TOF青少年和成年患者在我院接受了同期TOF修复术与PVR。我们回顾性收集了包括随访在内的医院记录数据。
患者的平均年龄为18.48±7.53岁。生物瓣膜尺寸范围为19毫米至25毫米。无早期或晚期死亡病例。没有患者发生严重的围手术期并发症。平均随访53.3±16.4个月时，与出院时相比，平均QRS时限、RV功能、RV收缩末期和舒张末期内径、RV心肌性能指数及功能状态（包括纽约心脏协会分级和6分钟步行试验）均无显著变化。4例患者出现人工瓣膜退变，伴有轻度PR，但压差无显著增加。
成年患者同期PVR与TOF修复术可提供良好的中期预后，肺动脉瓣退变率极低。它不仅缓解了术后早期病程，还在中期保留了RV功能以及功能状态。
