Fan-shaped expanded polytetrafluoroethylene valve in the pulmonary position.
BACKGROUND
Residual pulmonary insufficiency remains a problem after transannular repair in pediatric patients. We have developed fan-shaped monocuspid and bicuspid valves made of expanded polytetrafluoroethylene (ePTFE) membrane for repair of right ventricular outflow tract obstruction in patients with tetralogy of Fallot.


METHODS
We studied 20 patients (mean age, 39.6 months) with tetralogy of Fallot. The right ventricular outflow tract was reconstructed with use of a short, wide transannular patch and a fan-shaped valve made of 0.1-mm-thick expanded ePTFE membrane (PRECLUDE Pericardial Membrane, W.L. Gore & Associates, Inc, Flagstaff, AZ). The width of the valve and the outflow patch were constructed so that the neopulmonary annulus was approximately 130% the normal size.


RESULTS
A monocuspid valve was used in 17 patients and a bicuspid valve in 3. The mean follow-up time was 32.3 months (range, 14.7 to 56.7 months). Right ventricular function was well maintained in all patients. Valvular motion remained competent in 13 patients (65%). In the remaining 7 (35%), the valve became fixed in the open position. Trivial and mild pulmonary insufficiency was detected in 10 patients with a competent valve and 7 with an incompetent valve. No pressure gradient across the neopulmonary annulus or calcification of the expanded ePTFE membrane was detected in any patient.


CONCLUSIONS
The fan-shaped expanded ePTFE valve is a useful substitute with adequate function in transannular right ventricular outflow reconstruction.
Yamagishi
M
M
Department of Pediatric Cardiovascular Surgery Children's Research Hospital, Kyoto Prefectura University of Medicine, Kyoto, Japan. myama@koto.kpu-m.ac.jp
Kurosawa
H
H
Nomura
K
K
Kitamura
N
N
D001705:Bioprosthesis; D006348:Cardiac Surgical Procedures / Q000379:methods; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006334:Heart Function Tests; D006350:Heart Valve Prosthesis; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007223:Infant; D008297:Male; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D011665:Pulmonary Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D013771:Tetralogy of Fallot / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*
D011138:Polytetrafluoroethylene