title: Systemic-Pulmonary Shunt Facilitates the Growth of the Pulmonary Valve Annulus in Patients With Tetralogy of Fallot.
abstract: BACKGROUND
  Transannular patching (TAP) frequently accompanies primary repairs (PRs) in symptomatic neonates with tetralogy of Fallot (TOF). If a systemic-pulmonary shunt (SPS) facilitates the growth of the pulmonary valve annulus (PVA), patients with a marginally small PVA could benefit from a staged repair in terms of lowering the risk of TAP.
  
  
  METHODS
  Among 216 infants with TOF who underwent surgical intervention between January 2004 and December 2013, 29 infants underwent SPS with a subsequent repair (SPS group), whereas 187 infants received a PR (PR group). Median age and the Z-score of the PVA (PVA [Z]) at SPS were 32 days and -3.5, respectively. There was one late death and one follow-up loss after SPS, and preservation of the PVA was achieved on repair in 16 patients (16 of 29; 55%).
  
  
  RESULTS
  Multiple regression analysis showed that performance of SPS was the only indicator of the increase in the PVA (Z) in the entire cohort (n = 216). On mixed linear regression, the PVA (Z) increased significantly after the placement of an SPS (-3.6 + 0.2*duration in months, p = 0.001), whereas the prerepair changes in the PVA (Z) were not statistically significant in the PR group (p = 0.7), with a significant intergroup difference (p < 0.001). Receiver operating characteristic curve analysis showed that placement of TAP is expected when the preshunt PVA (Z) is smaller than -4.2 (area under the curve: 0.82; 95% confidence interval: 0.62 to 1.00; sensitivity, 100%; specificity, 73%).
  
  
  CONCLUSIONS
  SPS facilitates outgrowth of the PVA over somatic growth in patients with TOF. However, preservation of the PVA may not be achieved on staged repair if the initial PVA is too small.
authors: Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors: Byung Kwon
authors: BK
authors: Chong
authors: Division of Pediatric Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors: Jae Suk
authors: JS
authors: Baek
authors: Seoul Women's College of Nursing, Seoul, Republic of Korea.
authors: Yu-Mi
authors: YM
authors: Im
authors: Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors: Chun Soo
authors: CS
authors: Park
authors: Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors: Jeong-Jun
authors: JJ
authors: Park
authors: Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address: tjyun@amc.seoul.kr.
authors: Tae-Jin
authors: TJ
authors: Yun
mesh_terms: D058366:Blalock-Taussig Procedure / Q000379:methods*; D058385:Cardiac Valve Annuloplasty / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D011664:Pulmonary Valve / Q000254:growth & development / Q000601:surgery*; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013771:Tetralogy of Fallot / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome