title: Evolving strategies for preserving the pulmonary valve during early repair of tetralogy of Fallot: mid-term results.
abstract: BACKGROUND
  The aim of the study was to evaluate our results with pulmonary valve (PV) preservation in selected patients with tetralogy of Fallot (TOF).
  
  
  METHODS
  From January 2007, 69 patients who underwent early transatrial TOF repair were enrolled in the study. The patients were divided into 2 groups: PV preservation by PV annulus balloon dilation (group 1) and PV cusp reconstruction after annular incision (group 2).
  
  
  RESULTS
  Thirty-four patients underwent a successful PV annular preservation (49%). Median age at surgery was 113 days (range, 36-521 days) (group-1 vs group-2, P = not significant). Median preoperative PV Z score was -3.15 (range, -0.95 to -5.62) (group-1 vs group-2, P = .03). Median intensive care unit and hospital stays were 3 and 10 days, respectively (group 1 vs group 2, P = not significant). Median follow-up time was 580 days (range, 189-1940 days) (group 1 vs group 2, P = .08). Two patients were reoperated for residual right ventricular outflow tract (RVOT) obstruction (1 in group 1 and 1 in group 2). The remaining patients are alive and well. Median peak RVOT gradient was 25 mm Hg (range, 8-60 mm Hg) (group 1 vs group 2, P = not significant). The degree of PV regurgitation in group 1 was none/mild in 24 patients (80%) and moderate in 6 (20%) and was none/mild in 8 patients (25%), moderate in 11 (34.4%), and severe in 13 (28.6%) in group 2 (P = .001). Median right ventricular fractional area change was 55% (range, 42%-70%) in group 1 and 50% (range, 40%-63%) in group 2 (P = .003).
  
  
  CONCLUSIONS
  The integrity and function of the PV can be preserved in selected patients during early repair of TOF by concomitant balloon dilation, leading to a better mid-term right ventricular function.
authors: Department of Cardiac, Thoracic and Vascular Surgery, Pediatric and Congenital Cardiac Surgery Unit, University of Padua, Padua, Italy.
authors: Vladimiro L
authors: VL
authors: Vida
authors: Department of Cardiac, Thoracic and Vascular Surgery, Pediatric and Congenital Cardiac Surgery Unit, University of Padua, Padua, Italy.
authors: Alvise
authors: A
authors: Guariento
authors: Department of Pediatrics, Pediatric Cardiology Unit, University of Padua, Padua, Italy.
authors: Biagio
authors: B
authors: Castaldi
authors: Statistics Consultant, Department of Cardiac, Thoracic and Vascular Surgery, University of Padua, Padua, Italy.
authors: Matteo
authors: M
authors: Sambugaro
authors: Department of Cardiac, Thoracic and Vascular Surgery, Pediatric and Congenital Cardiac Surgery Unit, University of Padua, Padua, Italy.
authors: Massimo A
authors: MA
authors: Padalino
authors: Department of Pediatrics, Pediatric Cardiology Unit, University of Padua, Padua, Italy.
authors: Ornella
authors: O
authors: Milanesi
authors: Department of Cardiac, Thoracic and Vascular Surgery, Pediatric and Congenital Cardiac Surgery Unit, University of Padua, Padua, Italy. Electronic address: giovannistellin@unipd.it.
authors: Giovanni
authors: G
authors: Stellin
mesh_terms: D063126:Balloon Valvuloplasty / Q000009:adverse effects / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D011664:Pulmonary Valve / Q000503:physiopathology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000401:mortality; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013771:Tetralogy of Fallot / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D016278:Ventricular Function, Right
keywords: 20; 35; PV; RCA; RV; RVFAC; RVOT; TOF; VSD; pulmonary valve; right coronary artery; right ventricle fraction of area change; right ventricular; right ventricular outflow tract; tetralogy of Fallot; ventricular septal defect