title: Preservation of the pulmonary annulus in total correction of tetralogy of Fallot. Decreasing transannular gradients in the early follow-up period.
abstract: The integrity of the pulmonary annulus was preserved in 21 of 22 children consecutively subjected to total correction of tetralogy of Fallot. There was one early death (4.8%). The 20 survivors were studied prospectively and constitute the basis of this report. Mean age was 59.3 +/- 35.3 months (range 6 months-12 years). Eight patients (40%) had previous Blalock-Taussig shunts and 3 (15%) had associated cardiac anomalies. Two-dimensional Doppler echocardiography had demonstrated right ventricle to main pulmonary artery peak systolic gradients of 75.4 +/- 12.7 mmHg (range 50-104 mmHg). Ventricular infundibulectomy was carried out in all patients but one, who had abnormal coronary anatomy. Extensive incision or resection of hypertrophied or abnormal muscle bands was performed. Pulmonary valve commissurotomy was performed in 14 patients (70%), 10 (50%) had autologous pericardium supravalvular enlargement of the pulmonary trunk and one (5%) had an infundibular bovine pericardial patch. Intraoperative, postrepair right/left ventricular pressure ratios were 0.67 +/- 0.18 (range 0.41-1.0). All ratios were accepted, because all patients were haemodynamically well and only two required inotropic (dopamine) support. There was no late mortality. During the early follow-up period (mean 13.0 +/- 5.4 months, range 7-25 months), all patients had two-dimensional Doppler echocardiography measured gradients at discharge (mean 44.2 +/- 22.6 mmHg, range 10-86 mmHg; p less than 0.001 vs. preoperative values), at 3 months (mean 31.1 +/- 14.5 mmHg, range 8-64 mmHg; p less than 0.011 vs. values at discharge) and at 6 months (mean 28.5 +/- 14.3 mmHg, range 12-57 mmHg; p = 0.009 vs. values at discharge). A similar favourable evolution of the diameters of the pulmonary annulus and of the right pulmonary artery was observed.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Division of Cardio-thoracic Surgery, University Hospital, Coimbra, Portugal.
authors.forename: M J
authors.initials: MJ
authors.lastname: Antunes
authors.forename: E
authors.initials: E
authors.lastname: Castela
authors.forename: M F
authors.initials: MF
authors.lastname: Sanches
authors.forename: A S
authors.initials: AS
authors.lastname: Melo
mesh_terms: D055592:Biophysical Phenomena; D001703:Biophysics; D002648:Child; D002675:Child, Preschool; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000502:physiology; D011664:Pulmonary Valve / Q000601:surgery*; D013771:Tetralogy of Fallot / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016278:Ventricular Function, Right / Q000502:physiology