Short-term hemodynamic results after right ventricular outflow tract reconstruction using a cusp-bearing transannular patch.
Correction of right ventricular outflow tract obstruction remains a challenge to cardiovascular surgeons. In order to relieve this obstruction and at the same time prevent or minimize pulmonary insufficiency, we inserted a cusp-bearing transannular patch (monocusp) in 14 patients. To test this objective, we restudied 13 of these patients 0.5 to 4 months postoperatively, including quantifying pulmonary insufficiency using an accurate videodensitometric method. In all patients a degree of pulmonary insufficiency ranging from 8% to 46% of total stroke volume (mean 22.7 +/- 10.6%) was measured, and in all but one a residual right ventricular outflow pressure gradient of 2 to 22 mm Hg (mean 10 +/- 7 mm Hg) was measured. There was an inverse relation between the degree of pulmonary insufficiency and both the pressure gradient (r = -0.89) and the ratio of the pulmonary valve ring diameter to monocusp depth (r = -0.67). An ideal reconstruction of the right ventricular outflow tract obstruction, without any postoperative pulmonary insufficiency and stenosis, was not achieved by the implantation of a monocusp in the described fashion. The postoperative results were acceptable in only a few patients. A reduction of pulmonary insufficiency seems to be associated with a small residual pressure gradient as well as a relatively small cusp size. Additional studies are necessary to further improve surgical correction of right ventricular outflow tract obstruction with reproducible and predictable results.
D000293:Adolescent; D000328:Adult; D002302:Cardiac Output; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D011665:Pulmonary Valve Insufficiency / Q000209:etiology; D011666:Pulmonary Valve Stenosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D013318:Stroke Volume; D013771:Tetralogy of Fallot / Q000150:complications / Q000503:physiopathology / Q000601:surgery*