PMID- 10219546
OWN - NLM
STAT- MEDLINE
DCOM- 19990616
LR  - 20190513
IS  - 1010-7940 (Print)
IS  - 1010-7940 (Linking)
VI  - 15
IP  - 2
DP  - 1999 Feb
TI  - Homograft valve insertion for pulmonary regurgitation late after valveless repair 
      of right ventricular outflow tract obstruction.
PG  - 143-9
AB  - OBJECTIVE: Pulmonary regurgitation after valveless repair of right ventricular 
      outflow tract obstruction (RVOTO) results in progressive right ventricular (RV) 
      dilatation and dysfunction in an increasing number of patients. Since 1989, we 
      have exclusively used cryopreserved homografts to restore pulmonary valve 
      competence in these patients. Our 9-year-experience with pulmonary valve 
      insertion (PVI) in such cases has been reviewed to evaluate the indications for 
      this procedure and its benefits. METHODS: From 1989 to 1998, 49 patients 
      (original diagnosis: tetralogy of Fallot in 42 patients and pulmonary stenosis in 
      seven) aged from 3 to 42 years (mean 18 +/- 9 years) underwent PVI with 
      homografts late (mean 13 +/- 7 years) after valveless repair of RVOTO 
      (transannular patch, n = 38; pulmonary valvulotomy therefore tau chi infundibular 
      patch, n = 11). Preoperatively, all patients had severe pulmonary regurgitation, 
      cardiomegaly, significant to severe RV dilatation and dysfunction, fatigue, 
      reduced exercise tolerance, and were in NYHA class II (n = 43) or III (n = 6). 
      Ten patients had ventricular arrhythmia. RESULTS: There was one early death, due 
      to air embolism, and one late death, due to ventricular arrhythmia. All survivors 
      but one, who subsequently underwent heart transplant, had symptomatic improvement 
      after homograft insertion. The mean RV end-diastolic diameter decreased from 38 
      +/- 9 to 26 +/- 8 mm (P < 0.01), and cardiothoracic ratio decreased from 0.62 +/- 
      0.07 to 0.54 +/- 0.04 (P < 0.01). Good late homograft function was the rule, with 
      all the survivors being free of reoperation for valve failure. At a mean 
      follow-up of 42 +/- 28 months, 41 patients (87% of the survivors) were in New 
      York Heart Association (NYHA) class I and six in class II. Within this group 
      three patients are still in treatment for RV failure and five for ventricular 
      arrhythmias. In these patients, the average interval between RVOTO repair and PVI 
      was significantly longer than in the others (18 +/- 7 vs. 12 +/- 6 years, P < 
      0.01). CONCLUSION: Homograft PVI is safe and provides clinical improvement with a 
      significant reduction in RV volume overload and excellent mid-term results in 
      most patients with severe PR late after RVOTO repair. This procedure should be 
      undertaken early in symptomatic patients, before severe RV failure and 
      ventricular arrhythmias ensue.
FAU - Conte, S
AU  - Conte S
AD  - Department of Cardiac Surgery, Gasthui sberg University Hospital, Leuven, 
      Belgium.
FAU - Jashari, R
AU  - Jashari R
FAU - Eyskens, B
AU  - Eyskens B
FAU - Gewillig, M
AU  - Gewillig M
FAU - Dumoulin, M
AU  - Dumoulin M
FAU - Daenen, W
AU  - Daenen W
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Cardiac Surgical Procedures/adverse effects
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Follow-Up Studies
MH  - *Heart Valve Prosthesis Implantation
MH  - Humans
MH  - Male
MH  - Pulmonary Valve Insufficiency/etiology/*surgery
MH  - Reoperation
MH  - Retrospective Studies
MH  - Transplantation, Homologous
MH  - Treatment Outcome
MH  - Ventricular Outflow Obstruction/complications/*surgery
EDAT- 1999/04/29 00:00
MHDA- 1999/04/29 00:01
CRDT- 1999/04/29 00:00
PHST- 1999/04/29 00:00 [pubmed]
PHST- 1999/04/29 00:01 [medline]
PHST- 1999/04/29 00:00 [entrez]
AID - S1010794098003066 [pii]
AID - 10.1016/s1010-7940(98)00306-6 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 1999 Feb;15(2):143-9. doi: 
      10.1016/s1010-7940(98)00306-6.