title: A Novel Predictive Value for the Transannular Patch Enlargement in Repair of Tetralogy of Fallot.
abstract: BACKGROUND
  In tetralogy of Fallot, whether relieving right ventricular outflow tract obstruction requires transannular patch enlargement (TAPE) of the pulmonary valve depends on pulmonary valvular annulus size. The z-score of pulmonary annulus is most commonly used as a predictor of the need for TAPE. However, the z-score is a complex value affected by height, body weight, body surface area, and different reference populations. Therefore, we hypothesized that the great artery annulus size ratio (pulmonary valvular annulus size to aortic valve annuls size [GA ratio]) may be a better predictor of the need for TAPE.
  
  
  METHODS
  We analyzed 122 patients retrospectively who had undergone total correction of tetralogy of Fallot between January 2007 and March 2015. We categorized the patients into two groups, TAPE versus non-TAPE. Great arterial annuli sizes were evaluated in each group, and the GA ratio cutoff values for TAPE were calculated.
  
  
  RESULTS
  In total, 40 patients (32.8%) required TAPE. Both GA ratios and z-scores were smaller in the TAPE group than in the non-TAPE group (0.51 versus 0.67, p < 0.0001, and -2.46 versus -0.85, p < 0.0001, respectively). In receiver operating characteristics analyses, the z-score and GA ratio cutoff values were -1.67 (area under the curve = 0.797) and 0.56 (area under the curve = 0.900), respectively, demonstrating that the GA ratio was a more powerful diagnostic tool as a predictor of TAPE (p = 0.014).
  
  
  CONCLUSIONS
  Our results suggest that the GA ratio is a useful predictor for TAPE and can be applied readily and simply in clinical practice.
authors.affiliation: Research Institute for Convergence of Biomedical Science and Technology, and Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Kwang Ho
authors.initials: KH
authors.lastname: Choi
authors.affiliation: Research Institute for Convergence of Biomedical Science and Technology, and Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea. Electronic address: scsung21@hanmail.net.
authors.forename: Si Chan
authors.initials: SC
authors.lastname: Sung
authors.affiliation: Research Institute for Convergence of Biomedical Science and Technology, and Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Hyungtae
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Pediatric Cardiology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Hyung Doo
authors.initials: HD
authors.lastname: Lee
authors.affiliation: Department of Pediatric Cardiology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Gil Ho
authors.initials: GH
authors.lastname: Ban
authors.affiliation: Department of Pediatric Cardiology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Geena
authors.initials: G
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Hee Young
authors.initials: HY
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D001021:Aortic Valve / Q000033:anatomy & histology*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D009929:Organ Size; D011237:Predictive Value of Tests; D011664:Pulmonary Valve / Q000033:anatomy & histology*; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000601:surgery*