Reoperative double ventricular outflow tract reconstruction in grown-up congenital heart disease patients with conotruncal anomalies.
OBJECTIVE
Surgical experiences of the reoperative double ventricular outflow tract reconstruction long after the successful repair of conotruncal anomalies were reviewed.


METHODS
Ten adult patients with conotruncal anomalies (6 females, 22.9 ± 5.5 years old) underwent the reoperative double ventricular outflow tract reconstruction. Primary diagnosis was pulmonary atresia with ventricular septal defect in 6 patients, truncus arteriosus in 3, and double-outlet right ventricle in 1. The indication for the left ventricular outflow tract reconstruction was the left ventricular dilatation and dysfunction derived from moderate or greater systemic semilunar valve insufficiency. The indication for the right ventricular outflow tract reconstruction was severe pulmonary insufficiency in all patients, and concomitant right ventricular outflow tract obstruction in 7.


RESULTS
The systemic semilunar valve replacement was performed in all patients. The right ventricular outflow tract patching was performed in 4 patients, and the revision of extra-cardiac conduit in 6. Within a mean follow-up of 9.0 ± 7.0 years, there was no mortality. The left ventricular end-diastolic volume index improved from 147 ± 37 to 108 ± 19 ml/m(2) (p = 0.005), and the peak pressure gradient across right ventricular outflow tract improved from 43 ± 17 mmHg to 9 ± 2 at 1 year after (p = 0.02). The plasma brain natriuretic peptide level improved from 83 ± 57 to 34 ± 32 pg/ml (p = 0.03).


CONCLUSIONS
Reoperative double ventricular outflow tract reconstruction long after the repair of conotruncal anomalies was safely performed, and provided the ventricular reverse remodeling and improvement of serum BNP level.
Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, 565-8565, Osaka, Japan.
Kunio
K
Kusajima
Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, 565-8565, Osaka, Japan. thoashi@surg1.med.osaka-u.ac.jp.
Takaya
T
Hoashi
Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, 565-8565, Osaka, Japan.
Koji
K
Kagisaki
Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan.
Hideo
H
Ohuchi
Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan.
Isao
I
Shiraishi
Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, 565-8565, Osaka, Japan.
Hajime
H
Ichikawa
D000293:Adolescent; D000328:Adult; D001021:Aortic Valve / Q000601:surgery; D005260:Female; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006345:Heart Septal Defects, Ventricular / Q000503:physiopathology / Q000601:surgery; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D008297:Male; D018633:Pulmonary Atresia / Q000503:physiopathology / Q000601:surgery; D011665:Pulmonary Valve Insufficiency / Q000503:physiopathology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D014338:Truncus Arteriosus / Q000002:abnormalities; D014694:Ventricular Outflow Obstruction / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult
Cardiac surgery; Conotruncal anomaly; Grown-up congenital heart disease; Heart valve surgery; Reoperation