title: Secondary repair of incompetent pulmonary valves.
abstract: BACKGROUND
  Secondary repair of the pulmonary valve after right ventricular outflow tract (RVOT) reconstruction is infrequently reported. This article describes possible techniques of secondary pulmonary valve repair and reports follow-up results.
  
  
  METHODS
  Secondary pulmonary valve repairs in 7 patients (5 children and 2 adults) in our institution were reviewed. All patients presented with a severe pulmonary valve regurgitation associated with RV dilatation and dysfunction after primary RVOT reconstruction.
  
  
  RESULTS
  The surgical techniques varied in our series, but secondary repair of the incompetent pulmonary valve was possible in all patients. Follow-up was complete, with a mean follow-up of 4.1 +/- 2.7 years. There were no operative or late deaths in our group. All valves were repaired successfully, with a mean regurgitation grade of 1.28 +/- 0.5 postoperatively. The mean transvalvular gradient was 20 +/- 4.1 mm Hg for children and 22.5 +/- 3.5 mm Hg for adults, and no significant increase of pulmonary valve regurgitation occurred during follow-up. The mean RV dilatation index (RVDI) decreased significantly from 0.85 +/- 0.25 to 0.6 +/- 0.2 for children and from 1.4 +/- 0.01 to 0.9 +/- 0.05 for adults.
  
  
  CONCLUSIONS
  Our results showed functional recovery of the right ventricle after reoperation, with RVDI recovering to almost normal values in children. No significant regurgitation of the secondarily reconstructed pulmonary valve was observed during the 4-year follow-up period. Secondary repair for pulmonary valve incompetence after RVOT procedures might be a valuable alternative to conduit replacement.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Germany. nestoras.papadopoulos@gmail.com
authors.forename: Nestoras
authors.initials: N
authors.lastname: Papadopoulos
authors.forename: Anoosh
authors.initials: A
authors.lastname: Esmaeili
authors.forename: Andreas
authors.initials: A
authors.lastname: Zierer
authors.forename: Farhad
authors.initials: F
authors.lastname: Bakhtiary
authors.forename: Feyzan
authors.initials: F
authors.lastname: Ozaslan
authors.forename: Anton
authors.initials: A
authors.lastname: Moritz
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D011183:Postoperative Complications / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000601:surgery*; D011666:Pulmonary Valve Stenosis / Q000601:surgery*; D012086:Reoperation