title: Pulmonary Valve Repair for Patients With Acquired Pulmonary Valve Insufficiency.
abstract: BACKGROUND
  Pulmonary valve (PV) insufficiency is often an acquired condition after treatment for pulmonary stenosis. It is recognized that PV insufficiency has serious deleterious effects. Although surgical replacement of the PV is efficacious, artificial valves inevitably fail and require re-intervention. The purpose of this study was to summarize our experience with PV repair in patients with acquired PV insufficiency.
  
  
  METHODS
  This was a retrospective review of 16 patients with marked PV insufficiency who underwent PV repair. Thirteen of these patients were born with tetralogy of Fallot (TOF) and had undergone a previous transannular patch repair. Three patients were born with critical pulmonary stenosis and had a surgical valvotomy or balloon valvuloplasty.
  
  
  RESULTS
  The 13 patients with TOF had resection of their previously placed transannular patch with re-approximation of the anterior commissure. All 13 patients experienced a marked reduction in the degree of pulmonary insufficiency. None of these patients have experienced any increase in insufficiency during follow-up. The 3 patients with critical pulmonary stenosis had a variety of pathologic findings identified at the surgical procedure. One patient had a large gap between a commissure and underwent closure of that commissure. The second and third patients had torn leaflets repaired with pericardial and Gore-Tex patches (Gore, Inc, Flagstaff, AZ). The degree of PV insufficiency was decreased to mild in all 3 patients. However, 2 of these 3 patients have subsequently had an increase in the degree of pulmonary insufficiency.
  
  
  CONCLUSIONS
  Patients with TOF who underwent a previous transannular patch may be candidates for bicuspidization of their native PV, and the results of this procedure have been quite stable at follow-up. PV repair for torn leaflets was effective in the short term but was less stable over time.
authors.affiliation: Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, California.
authors.forename: Sameh M
authors.initials: SM
authors.lastname: Said
authors.affiliation: Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, California. Electronic address: mainwaring@stanford.edu.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Mainwaring
authors.affiliation: Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, California.
authors.forename: Michael
authors.initials: M
authors.lastname: Ma
authors.affiliation: Division of Pediatric Cardiology, Lucile Packard Children's Hospital/Stanford University, Stanford, California.
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Tacy
authors.affiliation: Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, California.
authors.forename: Frank L
authors.initials: FL
authors.lastname: Hanley
mesh_terms: D000800:Angioplasty, Balloon; D001705:Bioprosthesis; D002315:Cardiopulmonary Bypass; D017548:Echocardiography, Transesophageal; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D011664:Pulmonary Valve / Q000002:abnormalities / Q000473:pathology / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D011666:Pulmonary Valve Stenosis / Q000150:complications / Q000151:congenital / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D011138:Polytetrafluoroethylene