[Two-cusp plasty using a pedicled auto pericardial patch for the right ventricular outflow tract in complete repair of tetralogy of Fallot].
BACKGROUND
Pulmonary stenosis (PS) and regurgitation (PR) are major concerns late after transannular patching for tetralogy of Fallot (TOF). In this study, we reviewed the TOF patients undergoing transannular patching to reveal whether the valvuloplasty technique (two cusp plasty) improved long-term results. We also reviewed potential for grow of the pedicled autopericardial patch.


RESULTS
Since 1977, 151 patients underwent corrective surgery for TOF. Transannular patching was required in 58 (38.4%). PS and PR in the postoperative long-term period of these 59 cases were reviewed. 25 patients had the standard transannular patching (S-TAP), and 33 had two-cusp plasty (TCP). Pedicled autologous pericardial patch were used in 9 patients of TCP. Actuarial freedom from PS at 7 years was 70.8 +/- 9.2% in S-TAP and 79.2 +/- 8.3% in TCP, and there was no significant difference. Incidence of severe PR was significantly higher in S-TAP (7/24) than TCP (1/24) (p < 0.05). Actuarial freedom from PR at 7 year was 69.6 +/- 9.6% in the former and 95.8 +/- 4.2% in the later, respectively. The diameter of the pulmonary arterial annuals was augmented with the somatic growth in 6 patients with the pedicled pericardial patch.


CONCLUSIONS
Two cusp plasty was more effective to prevent PR in the postoperative long-term period, comparing to S-TAP. As the material of the patch, pedicled autologous pericardium showed satisfactory outcome.
Kitayama
H
H
Department of Cardiovascular Surgery, Kinki University School of Medicine, Osakasayama, Japan.
Oku
H
H
Matsumoto
T
T
D019917:Blood Vessel Prosthesis Implantation; D019918:Heart Valve Prosthesis Implantation; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D011665:Pulmonary Valve Insufficiency / Q000209:etiology; D011666:Pulmonary Valve Stenosis / Q000209:etiology; D019651:Plastic Surgery Procedures; D013771:Tetralogy of Fallot / Q000601:surgery*