Simultaneous enlargement of the pulmonary annulus and the pulmonary cusp with autologous pericardium in right ventricular outflow tract reconstruction.
BACKGROUND
Surgical repair of obstructive lesions of the right ventricular outflow tract (RVOT) commonly creates pulmonary valve incompetence, which continues to stimulate research for the optimal materials and surgical techniques to reconstruct RVOT. In this study, we present the early results with simultaneous enlargement of the pulmonary annulus and the pulmonary cusp with a transannular patch of autologous pericardium in RVOT reconstruction.


METHODS
From January 2003 to December 2005, the surgical technique of simultaneous enlargement of the pulmonary annulus and the pulmonary cusp was used in 32 patients who had complex congenital heart anomalies with pulmonary artery hypoplasia. The functional status of the patients was followed up in the cardiologic clinic of our institute. The motion of the newly constructed valve and the degree of pulmonary insufficiency were evaluated by echocardiography before discharge and at 2-6 months, 12 months, and 36 months postoperatively.


RESULTS
Early death occurred in one patient (3.1%). Postoperative complications occurred in six patients but they recovered uneventfully. During the follow-up, 28 of 31 operative survivors were in New York Heart Association functional class I without medication and the other three were in class II. Seventeen patients had no or trivial pulmonary regurgitation; mild regurgitation was present in 12 patients, and moderate regurgitation was seen in 2 patients. None of these patients needed reoperation and echocardiography showed good motion of the reconstructed valve.


CONCLUSIONS
The surgical technique of simultaneous enlargement of the pulmonary annulus and the pulmonary cusp with a transannular patch of autologous pericardium is a safe, reliable, and effective way for RVOT reconstruction. Satisfactory early results have been achieved; however, long-term follow-up is necessary to determine the true value of this technique.
Liu
Xue Gang
XG
Department of Cardiothoracic Surgery, Affiliated Hospital of Bengbu Medical College, Bengbu, China.
Wu
Kai Hong
KH
Li
Xiao Feng
XF
Shi
Chao
C
Wang
Zu Yi
ZY
Tang
Zhen
Z
Shi
Xiang Qian
XQ
Liu
Ying Long
YL
D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D010496:Pericardium / Q000601:surgery*; D011664:Pulmonary Valve / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods / Q000401:mortality; D013771:Tetralogy of Fallot / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D016278:Ventricular Function, Right