Echocardiography of the right ventricle-to-pulmonary artery homograft conduit of patients with transposition of the great arteries or double outlet right ventricle undergoing the Rastelli procedure.
BACKGROUND
Aortic valved homograft conduits have been valuable in right ventricular outflow tract (RVOT) reconstruction in complex congenital heart disease.


METHODS
Since 1995, 12 patients ranging in age from 3 to 22 years, with transposition of the great arteries or double outlet right ventricle associated with pulmonary stenosis and ventricular septal defect, underwent the Rastelli procedure with the RVOT reconstruction utilizing cryopreserved aortic valved homograft conduits.


RESULTS
Operative deaths for three patients were caused by the complexity of the heart defects (25%). One late death (8.33%) occurred as a result of pulmonary embolism one month after conduit implantation. The remaining eight patients (66.67%) survived asymptomatically with a mean postoperative hospitalization of 22 days. Preoperative Doppler echocardiographic flow visualization distinguished not only the corresponding location among the atrium, ventricle and great arteries, but also intracardiac. Mosaic flow pattern could be detected in the right ventricle and right atrium (n = 11). Postoperative echocardiographic flow visualization showed the valved homograft extracardiac conduit lay between the right ventricle and the pulmonary artery, and the valve inside the conduit could faintly be seen. Mosaic flow pattern could be observed with the systole and diastole jet in the cardiac circle (n = 8). Peak velocity and pressure gradient across the pulmonary valve after the Rastelli procedure were significantly decreased when compared with those before operation (4.13 +/- 0.44 m/s vs. 3.15 +/- 1.13 m/s, p = 0.032; 72.46 +/- 15.79 mmHg vs. 39.87 +/- 23.23 mmHg, p = 0.003). However, there were no significant differences between pre- and postoperative peak velocity and pressure gradient beyond the pulmonary valve.


CONCLUSIONS
Apart from operative mortality, the application of aortic valved homograft conduits were all excellent choice for the correction of complex congenital heart disease.
Yüan
S M
SM
Department of Surgery, Fuwai Heart Hospital, Chinese Academy of Medical Sciences, Beijing, P.R.C.
Zhang
L S
LS
Xu
Q Z
QZ
Guo
J Q
JQ
D000293:Adolescent; D000328:Adult; D001021:Aortic Valve / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015150:Echocardiography, Doppler; D006352:Heart Ventricles / Q000002:abnormalities*; D006801:Humans; D011651:Pulmonary Artery / Q000601:surgery*; D011652:Pulmonary Circulation; D014188:Transposition of Great Vessels / Q000000981:diagnostic imaging / Q000601:surgery*