title: [Right ventricular outflow tract reconstruction in adolescents and adults after previous repair of congenital heart defects].
abstract: Due to successful surgical treatment of congenital heart defects in infants and children, the number of patients who reach the adolescent/adult age is continuously increasing.
  
  
  OBJECTIVE
  The authors sought to identify the short- and medium-term outcomes of reconstruction of right ventricular outflow tract in adolescents and adults who underwent surgical intervention for congenital heart defect in infancy or early childhood.
  
  
  METHODS
  Between 2001 and 2012, 48 patients (age: 15-39, mean 21 years) (30 tetralogy of Fallot, 11 pulmonary atresia + ventricular septal defect, 6 transposition of great arteries + ventricular septal defect + left ventricular outflow tract obstruction, and 1 truncus arteriosus) had repeat operation because of right ventricular dysfunction. All patients previously underwent right ventricular outflow tract procedures in early childhood.
  
  
  RESULTS
  In 31 patients, the small homograft, and in 9 patients the transannular-paths were replaced for "adult-size" homograft. Bioprosthetic pulmonary valve replacement was performed in pulmonary (6 patients) and homograft annuli (2 patients). In 14 patients, resection of the right ventricular outflow tract aneurism was also necessary to be performed. There was no early and mid-time (10 years) mortality. In 97.5% of patients with homograft-re-implantation, there was no need for repeat intervention for 5 years.
  
  
  CONCLUSIONS
  The right ventricular outflow tract restoration in adolescents and adults is an effective procedure. The reconstruction should be performed in early adolescent period to prevent right ventricular dysfunction. The authors prefer using bioprosthetic pulmonary valve replacement in patients with adult-size pulmonary or homograft annulus.
authors: Gottsegen György Országos Kardiológiai Intézet Budapest. 1096. hartyanszky@hotmail.com
authors: István
authors: I
authors: Hartyánszky
authors: László
authors: L
authors: Székely
authors: László
authors: L
authors: Szudi
authors: Sándor
authors: S
authors: Mihályi
authors: Krisztina
authors: K
authors: Kádár
authors: András
authors: A
authors: Temesvári
authors: Hajnalka
authors: H
authors: Bálint
authors: András
authors: A
authors: Szatmári
authors: Attila
authors: A
authors: Tóth
mesh_terms: D000293:Adolescent; D000328:Adult; D000783:Aneurysm / Q000601:surgery; D000790:Angiocardiography; D001705:Bioprosthesis; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications* / Q000601:surgery*; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D018633:Pulmonary Atresia / Q000150:complications / Q000601:surgery; D011664:Pulmonary Valve / Q000601:surgery; D012086:Reoperation; D013771:Tetralogy of Fallot / Q000150:complications / Q000601:surgery; D014188:Transposition of Great Vessels / Q000150:complications / Q000601:surgery; D016896:Treatment Outcome; D014338:Truncus Arteriosus / Q000601:surgery; D014694:Ventricular Outflow Obstruction / Q000209:etiology* / Q000601:surgery*; D055815:Young Adult