title: Reconstruction of the pulmonary valve and outflow tract with bicuspid prosthesis in tetralogy of Fallot.
abstract: BACKGROUND
  Right ventricular outflow tract and pulmonary valve implant in patients with tetralogy of Fallot may be required to avoid late postoperative right ventricular impairment. The use of porcine bicuspid prosthesis might be a technical alternative, although comprehensive studies on the long-term use of these prostheses are not available.
  
  
  METHODS
  Sixty-three patients (aged 5 months to 34 years; mean, 6 years) with tetralogy of Fallot and pulmonary hypoplasia underwent surgical repair and enlargement of the right ventricular outflow using preserved porcine pulmonary bicuspid prostheses. Fifty-two patients (82.5%) were followed and underwent clinical evaluation and serial Doppler echocardiography. The first 15 patients (29.4%), with ages ranging from 5 to 16 years (mean, 8.2 years) and postoperative follow-up of 48 to 87 months (mean, 65.1 months) underwent hemodynamic and cineangiographic evaluations.
  
  
  RESULTS
  There were 11 deaths (17.4%) in the early postoperative period. Of the 52 surviving patients (82.5%), 51 (80.9%) were followed for 1 to 87 months (mean, 42.0 months). Four patients (7.6%) had additional treatment. Of the 15 patients (29.1%) undergoing hemodynamic evaluation, 9 (60%), had mild valvular pulmonary insufficiency and 6 (40%) had moderate insufficiency. Only the right ventricle-to-pulmonary artery pressure gradients and the right ventricular ejection fraction showed statistically significant differences between groups. Right ventricular dimension, although increased in all patients, did not show statistically significant differences.
  
  
  CONCLUSIONS
  Right ventricular outflow tract and pulmonary valve repair in patients with tetralogy of Fallot using a bicuspid porcine pulmonary prosthesis is a simple, reliable procedure with good results in postoperative medium term follow-up.
authors.affiliation: Division of Cardiovascular Surgery, Universidade Federal, São Paulo, Brazil. miguel@bes-way.com.br
authors.forename: M A
authors.initials: MA
authors.lastname: Maluf
authors.forename: D M
authors.initials: DM
authors.lastname: Braile
authors.forename: C
authors.initials: C
authors.lastname: Silva
authors.forename: R
authors.initials: R
authors.lastname: Catani
authors.forename: A C
authors.initials: AC
authors.lastname: Carvalho
authors.forename: E
authors.initials: E
authors.lastname: Buffolo
mesh_terms: D000293:Adolescent; D000328:Adult; D001705:Bioprosthesis; D002648:Child; D002675:Child, Preschool; D002932:Cineangiography; D015150:Echocardiography, Doppler; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis; D011664:Pulmonary Valve / Q000601:surgery*; D013771:Tetralogy of Fallot / Q000175:diagnosis / Q000601:surgery*