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Khajali Z, Mohammadi N, Toloueitabar Y, Maleki M, Saedi S, nourouzi Z, Mazloum-Zadeh S, Chenaghloo M, Jalali A, Tatari H, Aliramezany M. Midterm prognosis following total correction of tetralogy of fallot in adult patients. Front Cardiovasc Med 2023; 10:1254022. [PMID: 37908505 PMCID: PMC10613674 DOI: 10.3389/fcvm.2023.1254022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/25/2023] [Indexed: 11/02/2023] Open
Abstract
Background Tetralogy of Fallot is a common congenital heart disease characterized by cyanosis. The primary treatment approach involves corrective surgery typically performed within the first year of life to achieve complete resolution. However, certain patients may undergo surgery at an older age. This study seeks to assess the efficacy of surgery by examining the midterm outcomes of total correction of Tetralogy of Fallot when performed in older individuals. Methods This interventional-longitudinal study focused on patients who underwent complete surgery to correct tetralogy of Fallot at an advanced age of over 15 years. All of the participants were referred to the Shahid Rajaei Heart and Vascular Center, which is a referral center for congenital heart diseases in Iran, between 2010 and 2020. The surgical procedures for these patients involved primary total correction of tetralogy of Fallot or surgery following by shunt implantation. Prior to the surgery, the necessary information was gathered from the patients' medical records. The patients were then monitored over a 5-year period, during which they received regular check-ups from cardiologist with fellowship in adult congenital heart disease. Results A total of 94 participants were enrolled in the study, with an average age of 26.7 ± 9.6 years. Notably, the majority of the participants were male. The study reported a late mortality rate of 3.2%. Furthermore, 17 patients, constituting 18% of the cohort, underwent a secondary surgical procedure. This secondary surgery encompassed 14 cases of Pulmonary Valve Replacement (14.8%) and 3 cases of Ventricular Septal Defect repair (3.1%). Conclusion While the optimal age for total correction of Tetralogy of Fallot is conventionally considered to be within the first year of life, this study demonstrated that surgical intervention performed at a later stage of life can yield favorable midterm prognoses. It is imperative to emphasize that individuals unable to undergo surgery at the ideal age due to a multitude of factors should not be deprived of the potential benefits associated with surgical intervention.
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Affiliation(s)
- Zahra Khajali
- Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nasibeh Mohammadi
- Department of Cardiology, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Yaser Toloueitabar
- Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Maleki
- Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sedigheh Saedi
- Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zeinab nourouzi
- Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Saeideh Mazloum-Zadeh
- Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Chenaghloo
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amirhossein Jalali
- Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hassan Tatari
- Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Aliramezany
- Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
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Tandia AS, El Qady M, El Karimi S, Boumzebra D. Surgical Treatment Outcomes of Tetralogy of Fallot: Experience of the Cardiovascular Department of the Mohammed VI University Hospital in Marrakech. Cureus 2022; 14:e24773. [PMID: 35677003 PMCID: PMC9167490 DOI: 10.7759/cureus.24773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/05/2022] Open
Abstract
Background Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. The surgical approach to TOF continues to evolve, with many centers now favoring early repair for TOF. This study aimed to determine the prevalence of postsurgical complications such as pulmonary insufficiency, residual pulmonary stenosis, and interventricular communication. Methodology We conducted a cross-sectional, observational study with a descriptive and analytic focus involving 61 patients who were operated on for TOF. Results In total, 39 (63.9%) patients had a regular TOF and 22 (36.1%) had an irregular TOF. In our study, 32 (56.14%) patients had a pulmonary insufficiency, of whom 20 had a minimal pulmonary insufficiency (62.5% of pulmonary insufficiency cases), and 79.4% of patients with right ventricular outflow tract enlargement had pulmonary insufficiency (p < 0.005). Among patients who did not have a right ventricular outflow tract enlargement, three cases of pulmonary insufficiency were identified with a prevalence of 16.6%. Six (10.52%) patients had residual pulmonary stenosis. In addition, two (3.2%) cases of minimal residual ventricular septal defects were identified in this study. Conclusions Postoperative complications of TOF treatment are frequent and require medical care throughout the lifetime of patients.
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Ahsan AK, Sangi R, Ahmed S, Sohail A, Rehman MU, Raza A, Tebha SS, Qamar MA, Ashraf MM, Ali H. Predictors of short versus prolonged PCICU stay after primary repair of tetralogy of Fallot at a tertiary care unit, Karachi: A single-center study. Progress in Pediatric Cardiology 2022. [DOI: 10.1016/j.ppedcard.2022.101541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Blais S, Marelli A, Vanasse A, Dahdah N, Dancea A, Drolet C, Dallaire F. Comparison of Long-term Outcomes of Valve-Sparing and Transannular Patch Procedures for Correction of Tetralogy of Fallot. JAMA Netw Open 2021; 4:e2118141. [PMID: 34313740 PMCID: PMC8317016 DOI: 10.1001/jamanetworkopen.2021.18141] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
IMPORTANCE The choice of the right surgical technique for correction of tetralogy of Fallot (TOF) is contentious for patients with a moderate to severe right outflow tract obstruction. The use of a transannular patch (TAP) exposes patients to chronic pulmonary regurgitation, while valve-sparing (VS) procedures may incompletely relieve pulmonary obstruction. OBJECTIVE To compare 30-year outcomes of TOF repair after a VS procedure vs TAP. DESIGN, SETTING, AND PARTICIPANTS This retrospective population-based cohort study was conducted among all patients with TOF born in the province of Quebec, Canada, from 1980 to 2015 who underwent complete surgical repair. Patients who received a TAP or VS procedure were matched using a propensity score based on preoperative factors in a 1:1 ratio. Data were analyzed from March 2020 through April 2021. EXPOSURES The study groups were individuals who received TAP and those who received VS. The VS group was further stratified by the presence of residual pulmonary stenosis. MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality, with 30-year survival evaluated using Cox proportional-hazards models. Secondary outcomes included the cumulative mean number of cardiovascular interventions, pulmonary valve replacements (PVRs), and cardiovascular hospitalizations were evaluated using marginal means/rates regressions. RESULTS Among 683 patients with TOF (401 patients who underwent TAP [58.7%] and 282 patients who underwent a VS procedure [41.3%]), adequate propensity score matching was achieved for 528 patients (264 patients who underwent a VS procedure and 264 patients who underwent TAP). Among this study cohort, 307 individuals (58.1%) were men. The median (interquartile range [IQR]) follow-up was 16.0 (8.1-25.4) years, for a total of 8881 patient-years, including 63 individuals (11.9%) followed up for more than 30 years. Individuals who received a VS procedure had an increased 30-year survival of 99.1% compared with 90.4% for individuals who received TAP (hazard ratio [HR], 0.09 [95% CI, 0.02-0.41]; P = .002). Patients who underwent TAP had an increased 30-year cumulative mean number of cardiovascular interventions compared with patients who underwent a VS procedure without residual pulmonary stenosis (2.0 interventions [95% CI, 1.5-2.7 interventions] vs 0.7 interventions [95% CI, 0.5-1.1 interventions]; mean ratio [MR], 0.36 [95% CI, 0.25-0.50]; P < .001) and patients who underwent a VS procedure with at least moderate residual stenosis (1.3 interventions [95% CI, 0.9-1.9 interventions]; MR, 0.65 [0.45-0.93]; P = .02). Results were similar for PVR, with a 30-year cumulative mean 0.3 PVRs [95% CI, 0.1-0.7 PVRs] for patients who underwent a VS procedure without residual pulmonary stenosis (MR, 0.22 [95% CI, 0.12-0.43]; P < .001) and 0.6 PVRs (95% CI, 0.2-1.5 PVRs) for patients with at least moderate residual stenosis (MR, 0.44 [95% CI, 0.21-0.93]; P = .03), compared with 1.4 PVRs (95% CI, 0.8-2.5 PVRs) for the TAP group. No statistically significant difference was found for cardiovascular hospitalizations. CONCLUSIONS AND RELEVANCE This study found that patients who underwent a VS procedure had increased 30-year survival, fewer cardiovascular reinterventions, and fewer PVRs compared with individuals who underwent TAP, even in the presence of significant residual pulmonary stenosis. These findings suggest that it is beneficial to perform a VS procedure when possible, even in the presence of moderate residual stenosis, compared with the insertion of a TAP.
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Affiliation(s)
- Samuel Blais
- Department of Pediatrics, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Ariane Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence, McGill University Health Centre, Montreal, Québec, Canada
| | - Alain Vanasse
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada
| | - Adrian Dancea
- Division of Pediatric Cardiology, McGill University Health Centre, Montreal, Québec, Canada
| | - Christian Drolet
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire de Québec, Québec, Québec, Canada
| | - Frederic Dallaire
- Department of Pediatrics, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
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Blais S, Marelli A, Vanasse A, Dahdah N, Dancea A, Drolet C, Dallaire F. The TRIVIA Cohort for Surgical Management of Tetralogy of Fallot: Merging Population and Clinical Data for Real-World Scientific Evidence. CJC Open 2020; 2:663-670. [PMID: 33305226 PMCID: PMC7710944 DOI: 10.1016/j.cjco.2020.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/17/2020] [Indexed: 02/08/2023] Open
Abstract
Background Guidelines for surgical management of tetralogy of Fallot (TOF) are often based on low-quality evidence due to the many challenges of congenital heart disease: heterogeneous cardiac anatomy, consequences from surgical interventions arising years later, and scarcity of hard outcomes. The overarching goal of the Tetralogy of Fallot Research for Improvement of Valve replacement Intervention: A Bridge Across the Knowledge Gap (TRIVIA) study is to evaluate the long-term impact of the surgical management strategies in TOF. The specific objectives are: (1) to describe the long-term outcomes of TOF according to the native anatomy and the presence of genetic conditions, (2) to evaluate the long-term outcomes of surgical repair according to associated residual lesions, and (3) to evaluate the impact of paediatric pulmonary valve replacements on the long-term outcomes. Methods The TRIVIA study is a population-based cohort including all subjects with TOF in the province of Québec between 1980 and 2017. It links patient-level granular clinical data with long-term administrative health care data. We will evaluate mortality, cardiovascular interventions, and hospitalizations for adverse cardiovascular events using survival Cox models and marginal mean/rates models for recurrent events, respectively. Multivariate multilevel models will correct for potential confounders, and risk score matching will mitigate the potential of confounding by indication. Results The current TRIVIA cohort includes 1001 eligible subjects with TOF with complete lifelong follow-up for > 98%. The median follow-up is 17.1 years, totalling > 17,000 patient-years. Conclusions Universal health insurance data combined with granular clinical data enable the development of population-based cohorts, to which contemporary statistical methods are applied to address important research questions in congenital heart disease research.
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Affiliation(s)
- Samuel Blais
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.,Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Ariane Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence, McGill University Health Centre, Montreal, Québec, Canada
| | - Alain Vanasse
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada
| | - Adrian Dancea
- Division of Pediatric Cardiology, McGill University Health Center, Montreal, Québec, Canada
| | - Christian Drolet
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire de Québec, Québec City, Québec, Canada
| | - Frederic Dallaire
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.,Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
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Mahajan P, Ebenroth ES, Borsheim K, Husain S, Bo N, Herrmann JL, Rodefeld MD, Turrentine MW, Brown JW, Patel JK. Intermediate Outcomes of Staged Tetralogy of Fallot Repair. World J Pediatr Congenit Heart Surg 2019; 10:694-701. [PMID: 31701830 DOI: 10.1177/2150135119874035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The optimal surgical strategy for tetralogy of Fallot (TOF) repair in neonates and young infants requiring early surgical intervention remains controversial. Our surgical center follows the uniform strategy of a staged approach with initial systemic-to-pulmonary artery shunt the majority of time when early surgical intervention is required. We characterized a contemporary cohort of patients with TOF with pulmonary stenosis (PS) undergoing staged repair in order to determine the rate of pulmonary valve-sparing repair (PVSR), growth of the pulmonary valve annulus and pulmonary arteries, postoperative morbidity and mortality, and need for reintervention. METHODS We retrospectively studied patients with TOF/PS who underwent staged repair from 2000 to 2017. Surgical details, postoperative course, and reinterventions were noted. Echocardiographic measurements and Z-score values of pulmonary valve annulus, main pulmonary artery (MPA), right pulmonary artery (RPA), and left pulmonary artery (LPA) diameters were evaluated. RESULTS Of the 59 patients with staged TOF/PS, PVSR was performed in 25 (42%). There was a 5% incidence of postoperative arrhythmia. The Z-scores of MPA, RPA, and LPA were significantly higher before complete repair when compared to before palliative shunt. The 5 and 10-year survival rates were both 93%, and the probability of freedom from reoperation at 5 and 10 years was 87% and 82%, respectively. CONCLUSIONS Staged repair of TOF in young symptomatic infants results in 42% receiving PVSR, pulmonary artery growth, low incidence of postoperative arrhythmia, and relatively low rate of reoperations.
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Affiliation(s)
- Poonam Mahajan
- Division of Cardiology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Eric S Ebenroth
- Division of Cardiology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Kirsten Borsheim
- Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Sabena Husain
- Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Na Bo
- Department of Biostatistics, Indiana University, Indianapolis, IN, USA
| | - Jeremy L Herrmann
- Division of Cardiothoracic Surgery, Department of Surgery, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Mark D Rodefeld
- Division of Cardiothoracic Surgery, Department of Surgery, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Mark W Turrentine
- Division of Cardiothoracic Surgery, Department of Surgery, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - John W Brown
- Division of Cardiothoracic Surgery, Department of Surgery, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Jyoti K Patel
- Division of Cardiology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
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Vida VL, Triglia LT, Zanotto L, Zanotto L, Bertelli F, Padalino M, Sarris G, Protopapas E, Prospero C, Pizarro C, Cleuziou J, Myers PO, Prêtre R, Poncelet AJ, Meyns B, Van den Bossche K, Accord RE, Gil-Jaurena JM, Sakurai T, Stellin G. Late management of the aortic root after repair of tetralogy of Fallot: A European multicentre study. J Card Surg 2019; 35:40-47. [PMID: 31899837 DOI: 10.1111/jocs.14316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We sought to determine the indications, type, and outcomes of reoperations on the aortic root after repair of tetralogy of Fallot (TOF). METHODS Eleven centers belonging to the European Congenital Heart Surgeons Association contributed to the data collection process. We included 36 patients who underwent surgical procedures on the aortic root, including surgery on the aortic valve and ascending aorta, between January 1975 and December 2017. Original diagnoses included TOF-pulmonary stenosis (n = 18) and TOF-pulmonary atresia (n = 18). The main indications for reoperation were aortic insufficiency (n = 19, 53%), aortic insufficiency and dilatation of the ascending aorta (n = 10, 28%), aortic root dilatation (n = 4, 11%), and ascending aorta dilatation (n = 3, 8%). RESULTS The median age at reoperation was 30.4 years (interquartile range 20.3-45.3 years), and mechanical aortic valve replacement was the most common procedure performed. Five patients died early after reoperation (14%), and larger ascending aorta diameters were associated with early mortality (P = .04). The median age at the last follow-up was 41.4 years (interquartile range 24.5-51.6 years). Late death occurred in five patients (5/31, 16%). Most survivors (15/26, 58%) were asymptomatic at the last clinical examination (New York Heart Association, NYHA class I). The remaining patients were NYHA class II (n = 7) and III (n = 3). The most common symptoms were fatigue (n = 5), dyspnea (n = 4), and exercise intolerance (n = 3). CONCLUSIONS Reoperations on the aortic root are infrequent but may become necessary late after TOF repair. The main indications for reoperation are aortic insufficiency, either isolated or associated with a dilatation of the ascending aorta. The surgical risk at reoperation was high and the presence of ascending aorta dilation is related to higher mortality.
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Affiliation(s)
- Vladimiro L Vida
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Laura Torlai Triglia
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Lorenza Zanotto
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Lucia Zanotto
- Department of Statistical Sciences, University of Padua, Padua, Italy
| | - Francesco Bertelli
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Massimo Padalino
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - George Sarris
- Athens Heart Surgery Institute and Department of Paediatric and Congenital Cardiac Surgery, Iaso Children's Hospital, Athens, Greece
| | - Eleftherios Protopapas
- Athens Heart Surgery Institute and Department of Paediatric and Congenital Cardiac Surgery, Iaso Children's Hospital, Athens, Greece
| | - Carol Prospero
- Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Christian Pizarro
- Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Julie Cleuziou
- Department of Congenital and Paediatric Cardiac Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Patrick O Myers
- Division of Cardiovascular Surgery, University of Geneva, Geneva, Switzerland
| | - René Prêtre
- Cardiac Surgery Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Hospital, Lausanne, Switzerland
| | - Alain J Poncelet
- Cardio-Vascular Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium
| | - Bart Meyns
- Cardiac Surgery - UZ Leuven, Leuven, Belgium
| | | | - Ryan E Accord
- Pediatric and Congenital Cardio-Thoracic Surgery Unit, University Medical Center Groningen, Groningen, Netherlands
| | | | - Takahisa Sakurai
- Department of Cardiovascular Surgery, Chukyo Hospital, Nagoya, Japan
| | - Giovanni Stellin
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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Guné H, Sjögren J, Carlsson M, Gustafsson R, Sjöberg P, Nozohoor S. Right ventricular remodeling after conduit replacement in patients with corrected tetralogy of Fallot - evaluation by cardiac magnetic resonance. J Cardiothorac Surg 2019; 14:77. [PMID: 30987651 PMCID: PMC6466707 DOI: 10.1186/s13019-019-0899-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/01/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate the potential for right ventricular reverse remodelling after pulmonary valve replacement using cardiac magnetic resonance imaging, in adults with corrected tetralogy of Fallot and severe pulmonary insufficiency. Material and methods Ten patients with previous correction of tetralogy of Fallot with severe pulmonary insufficiency accepted for pulmonary valve replacement were evaluated prospectively with cardiac magnetic resonance imaging preoperatively and re-evaluated 10 ± 5 months postoperatively. Follow up for survival was 100% complete with mean of 37 ± 12 months. Results The preoperative mean indexed right ventricular end-diastolic volume was reduced from 161 ± 33 ml/m2 to 120 ± 23 ml/m2 postoperatively, p < 0.001. The preoperative mean indexed right ventricular stroke volume was reduced from 72 ± 20 ml/m2 to 50 ± 6 ml/m2 postoperatively, p = 0.002. After pulmonary valve replacement, the right ventricular ejection fraction did not change significantly (46% versus 42%, p = 0.337). Pulmonary insufficiency fraction decreased from 49% ± 11 to 1% ± 1 postoperatively, p < 0.001. Conclusions Pulmonary valve replacement leads to a favourable early reverse remodelling with a reduction in RV volumes and improved function in all patients regardless of their preoperative indexed right ventricular volume.
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Affiliation(s)
- Henrik Guné
- Department of Cardiothoracic Surgery, Clinical sciences, Lund University, Skane University Hospital, SE-221 85, Lund, Sweden
| | - Johan Sjögren
- Department of Cardiothoracic Surgery, Clinical sciences, Lund University, Skane University Hospital, SE-221 85, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Physiology, Clinical sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Ronny Gustafsson
- Department of Cardiothoracic Surgery, Clinical sciences, Lund University, Skane University Hospital, SE-221 85, Lund, Sweden
| | - Pia Sjöberg
- Department of Clinical Physiology, Clinical sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Shahab Nozohoor
- Department of Cardiothoracic Surgery, Clinical sciences, Lund University, Skane University Hospital, SE-221 85, Lund, Sweden.
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Llamosas-Falcón L, Bermejo-Sánchez E, Sánchez-Díaz G, Villaverde-Hueso A, Posada de la Paz M, Alonso-Ferreira V. Tetralogy of Fallot in Spain: a nationwide registry-based mortality study across 36 years. Orphanet J Rare Dis 2019; 14:79. [PMID: 30961612 PMCID: PMC6454694 DOI: 10.1186/s13023-019-1056-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/01/2019] [Indexed: 11/22/2022] Open
Abstract
Background Tetralogy of Fallot (TOF) is the most frequent cyanotic congenital heart defect. TOF mortality has fallen remarkably in recent years due to therapeutic advances. Accordingly, the aim of this study was to assess temporal and spatial variability in TOF-related mortality in Spain across the period 1981–2016, using data drawn from the nationwide population-based registry. Methods Annual deaths due to TOF were sourced from the Spanish National Institute of Statistics database by reference to International Classification of Diseases (ICD), 9th and 10th Revision codes, namely, ICD-9 code 745.2 (period 1981–1998) and ICD-10 code Q21.3 (period 1999–2016). Age-specific and age-adjusted mortality rates were calculated, as were standardised mortality ratios (SMRs) by province, district and municipality for the period 1999–2016. Results A total of 1035 deaths were attributed to TOF (57.78% of them were men and 42.22% were women). The age-adjusted mortality rate ranged from 0.75 per 1,000,000 inhabitants (95% confidence interval [CI]: 0–1.36) in 1981 to 0.03 per 1,000,000 (95% CI: 0.01–0.06) in 2016 for both sexes. In 2011, there was a change in the mortality trend, with a significant decrease of 49.22% per year (p < 0.001). In terms of geographical analysis, some areas with a significantly higher risk of TOF mortality were identified in the south of Spain, though no specific spatial pattern was in evidence. Conclusion The decrease in TOF mortality may be related to improvements in diagnostic and treatment techniques. More studies are needed to analyse regions with a higher mortality risk, in order to improve medical planning and resource allocation, and identify risk factors and preventive measures.
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Affiliation(s)
- Laura Llamosas-Falcón
- Preventive Medicine and Public Health, Hospital Universitario 12 de Octubre, 28041, Madrid, Spain
| | - Eva Bermejo-Sánchez
- Institute of Rare Diseases Research (IIER), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Germán Sánchez-Díaz
- Institute of Rare Diseases Research (IIER), Instituto de Salud Carlos III, 28029, Madrid, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), 28029, Madrid, Spain.,Department of Geology, Geography and Environmental Sciences, University of Alcala, 28801, Alcalá de Henares, Spain
| | - Ana Villaverde-Hueso
- Institute of Rare Diseases Research (IIER), Instituto de Salud Carlos III, 28029, Madrid, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), 28029, Madrid, Spain
| | - Manuel Posada de la Paz
- Institute of Rare Diseases Research (IIER), Instituto de Salud Carlos III, 28029, Madrid, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), 28029, Madrid, Spain
| | - Verónica Alonso-Ferreira
- Institute of Rare Diseases Research (IIER), Instituto de Salud Carlos III, 28029, Madrid, Spain. .,Centre for Biomedical Network Research on Rare Diseases (CIBERER), 28029, Madrid, Spain.
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Martins IF, Doles IC, Bravo-Valenzuela NJM, Santos AORD, Varella MSP. When is the Best Time for Corrective Surgery in Patients with Tetralogy of Fallot between 0 and 12 Months of Age? Braz J Cardiovasc Surg 2019; 33:505-510. [PMID: 30517260 PMCID: PMC6257527 DOI: 10.21470/1678-9741-2018-0019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 02/05/2018] [Indexed: 11/23/2022] Open
Abstract
Objective To identify the best time for corrective surgery of tetralogy of Fallot (TF)
in children aged 0-12 months and to report the most frequent complications
during the first 3 years postoperatively. Methods Systematic review of studies published between 2000 and 2017 on corrective
surgery for TF. Articles were selected through search of electronic
databases (PubMed, SciELO, Scopus, Lilacs, Google Scholar, and Cochrane).
Length of stay in intensive care unit, duration of mechanical ventilation,
and peri/postoperative complications were analyzed for data discussion and
research interpretation. Conclusion Definitive corrective surgery is the best alternative, and the earlier it is
performed, the lower the occurrence of harmful effects and the greater the
chances of cardiorespiratory recovery. This systematic review suggests that
the best time to perform definitive corrective surgery for TF in the first
year of life is during 3-6 months of age in children with no or mild
symptoms. Children with severe symptoms should undergo surgery
immediately.
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Affiliation(s)
| | - Iara C Doles
- Universidade de Taubaté (UNITAU), Taubaté, SP, Brazil
| | - Nathalie J M Bravo-Valenzuela
- Universidade de Taubaté (UNITAU), Taubaté, SP, Brazil.,Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
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11
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Kim DH, Lee JH, Choi ES, Park CS, Yun TJ. Optimal Pulmonary Valve Annulus Diameter for Annulus Preservation in Tetralogy of Fallot May Be Far Smaller Than Normal Annulus Size. Semin Thorac Cardiovasc Surg 2019; 31:253-263. [DOI: 10.1053/j.semtcvs.2018.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/30/2018] [Indexed: 11/11/2022]
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12
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Ho AB, Bharucha T, Jones E, Thuraisingham J, Kaarne M, Viola N. Primary surgical repair of tetralogy of Fallot at under three months of age. Asian Cardiovasc Thorac Ann 2018; 26:529-534. [PMID: 30217130 DOI: 10.1177/0218492318803037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Classical management of small infants with tetralogy of Fallot has involved placement of a Blalock-Taussig shunt followed later by complete repair, rather than primary complete repair which is the strategy adopted in larger infants. Some advantages of early complete repair compared to a staged strategy have been shown. We sought to review our institutional outcomes. Methods Patients under 3-months old undergoing complete surgical repair of tetralogy of Fallot in our institution between 2005 and 2015 were retrospectively reviewed and compared with an older control group matched by anatomical diagnosis and outflow tract intervention. Results Fourteen index cases (group A) and 14 controls (group B) were identified. At surgery, the median age was 43 days and weight 4.2 kg in group A, and 130 days and 6.1 kg in group B. Nine of 14 in group A were admitted for surgery as emergencies compared to none in group B. Peak inotrope score (22.3 vs. 12.8, p = 0.02) and intensive care unit stay (4.4 vs. 2.6 days, p = 0.02) were higher in group A. Bypass and crossclamp times, duration of intubation, and total length of stay did not differ. Conclusions We conclude that although babies undergoing early repair of tetralogy of Fallot have an increased need for intensive care support in the early postoperative period, the total length of stay is not prolonged despite more emergency admissions. As it is known that early repair may reduce long-term morbidity, we propose consideration of earlier complete repair of tetralogy of Fallot.
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Affiliation(s)
- Andrew B Ho
- 1 Department of Paediatric Cardiology, Southampton General Hospital, Southampton, UK
| | - Tara Bharucha
- 1 Department of Paediatric Cardiology, Southampton General Hospital, Southampton, UK
| | | | - Justin Thuraisingham
- 1 Department of Paediatric Cardiology, Southampton General Hospital, Southampton, UK
| | - Markku Kaarne
- 3 Department of Cardiothoracic Surgery, Southampton General Hospital, Southampton, UK
| | - Nicola Viola
- 3 Department of Cardiothoracic Surgery, Southampton General Hospital, Southampton, UK
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13
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Alassal M, Ibrahim BM, Elrakhawy HM, Hassenien M, Sayed S, Elshazly M, Elsadeck N. Total Correction of Tetralogy of Fallot at Early Age: A Study of 183 Cases. Heart Lung Circ 2018; 27:248-253. [DOI: 10.1016/j.hlc.2017.02.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 10/31/2016] [Accepted: 02/17/2017] [Indexed: 11/29/2022]
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14
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Bhat M, Mercer-Rosa L, Fogel MA, Harris MA, Paridon SM, McBride MG, Shults J, Zhang X, Goldmuntz E. Longitudinal changes in adolescents with TOF: implications for care. Eur Heart J Cardiovasc Imaging 2017; 18:356-363. [PMID: 28363199 DOI: 10.1093/ehjci/jew272] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 09/21/2016] [Indexed: 01/08/2023] Open
Abstract
Background We sought to identify predictors of change in right ventricular function and exercise capacity in adolescents following repair for tetralogy of Fallot. Methods and results We performed a longitudinal study with serial cardiac magnetic resonance imaging and/or exercise stress tests. Patients with interim intervention on the pulmonary valve were excluded. Paired t-test was used to detect longitudinal changes and multivariable regression models were built to identify predictors of change. Initial and follow up magnetic resonance and exercise stress test studies were available for 65 and 63 subjects, respectively. Age at initial testing was 11.7 ± 2.7 years. Average follow up time was 4.5 ± 1.8 (magnetic resonance) and 4.0 ± 1.6 (exercise test) years. There was a significant increase in right ventricular end diastolic and systolic volume (119 ± 34 to 128 ± 35 ml/m2, P = 0.006; 49 ± 20 to 56 ± 23 ml/m2, P = 0.001, respectively), and a decrease in right ventricular ejection fraction (60 ± 7 to 56 ± 8%, P = 0.001), with no significant change in pulmonary regurgitant fraction or right ventricular cardiac index. Predictors of right ventricular dilation over time included: time elapsed from surgical repair, severity of pulmonary insufficiency and right ventricular dilation at the initial magnetic resonance imaging. Of those, time elapsed from surgical repair had the most significant effect. There was no change in exercise capacity. Discussion In the adolescent with tetralogy of Fallot, longer time from surgery, more pulmonary insufficiency and greater right ventricular dilation at initial magnetic resonance imaging are associated with progressive right ventricular dilation. These results suggest early monitoring with magnetic resonance imaging might identify those at highest risk for progressive disease.
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Affiliation(s)
- Misha Bhat
- Department of Pediatric Cardiology, Pediatric Heart Center, Avd 67 Skåne University Hospital in Lund, SE-221-85 Lund, Sweden
| | - Laura Mercer-Rosa
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 34th and Civic Center Boulevard, 8th floor Philadelphia PA 19104, USA
| | - Mark A Fogel
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 34th and Civic Center Boulevard, 8th floor Philadelphia PA 19104, USA
| | - Matthew A Harris
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 34th and Civic Center Boulevard, 8th floor Philadelphia PA 19104, USA
| | - Stephen M Paridon
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 34th and Civic Center Boulevard, 8th floor Philadelphia PA 19104, USA
| | - Michael G McBride
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 34th and Civic Center Boulevard, 8th floor Philadelphia PA 19104, USA
| | - Justine Shults
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, 423 Guardian Dr, Philadelphia, PA 19104, USA
| | - Xuemei Zhang
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, 423 Guardian Dr, Philadelphia, PA 19104, USA
| | - Elizabeth Goldmuntz
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 34th and Civic Center Boulevard, 8th floor Philadelphia PA 19104, USA
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Bhat M, Goldmuntz E, Fogel MA, Rychik J, Mercer-Rosa L. Longitudinal Validation of the Diastolic to Systolic Time-Velocity Integral Ratio as a Doppler-Derived Measure of Pulmonary Regurgitation in Patients with Repaired Tetralogy of Fallot. Pediatr Cardiol 2017; 38:240-246. [PMID: 27837302 PMCID: PMC5332275 DOI: 10.1007/s00246-016-1505-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/27/2016] [Indexed: 11/28/2022]
Abstract
Pulmonary regurgitation (PR) is a common residual lesion and major determinant of outcome following surgical repair for tetralogy of Fallot. We sought to longitudinally study a previously described echocardiographic index as a correlate of PR measured by cardiac magnetic resonance imaging (CMR). We conducted a retrospective longitudinal study of patients with baseline and follow-up echocardiogram and CMR. The baseline studies were obtained as part of a research protocol, while the follow-up studies were performed for clinical purposes. On echocardiogram, the ratio of diastolic and systolic time-velocity integrals (DSTVI) in the main pulmonary artery was calculated. The Wilcoxon matched-pairs signed-rank test was used to test for individual changes in PR on echocardiogram and CMR. A linear regression of pulmonary valve regurgitant fraction (RF) was fit on DSTVI to identify clinically meaningful cut points of DSTVI. Thirty-five subjects were included, age at follow-up 18.3 ± 3.5 years. The follow-up between consecutive CMRs was a median time of 60 months (interquartile range 46-73). There was a moderate correlation between DSTVI and PR measured as RF by CMR (r = 0.62, p = 0.0001). A CMR RF of 20 and 40 % (the boundaries between mild/moderate and moderate/severe PR) corresponded with DSTVI of 0.52 and 0.79 (95 % CI 0.39; 0.66, and 0.69; 89), respectively. There was no significant change in either DSTVI (p = 0.61) or PR (p = 0.89) from baseline to follow-up. This study lends further credence to the DSTVI as an accurate reflection of PR. This index might become helpful in the routine echocardiographic assessment of PR. Further studies are needed to determine whether changes in RF by CMR result in changes in DSTVI.
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Affiliation(s)
- Misha Bhat
- Department of Pediatric Cardiology, Pediatric Heart Center, Skane University Hospital and Clinical Sciences, Lund University, Lund, Sweden
| | - Elizabeth Goldmuntz
- Division of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Mark A Fogel
- Division of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Jack Rychik
- Division of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Laura Mercer-Rosa
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA.
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16
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Moon TJ, Choueiter N, Geva T, Valente AM, Gauvreau K, Harrild DM. Relation of biventricular strain and dyssynchrony in repaired tetralogy of fallot measured by cardiac magnetic resonance to death and sustained ventricular tachycardia. Am J Cardiol 2015; 115:676-80. [PMID: 25727084 DOI: 10.1016/j.amjcard.2014.12.024] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 12/01/2014] [Accepted: 12/01/2014] [Indexed: 12/20/2022]
Abstract
Ventricular strain and dyssynchrony can be measured in patients with repaired tetralogy of Fallot (TOF), but their effect on clinical outcomes is poorly understood. The purpose of this study was to investigate if ventricular strain and dyssynchrony measured by cardiac magnetic resonance feature tracking are associated with death and sustained ventricular tachycardia. Patients with TOF who died or had ventricular tachycardia (TOF case, n = 16) were compared with age-matched patients with TOF with no adverse outcome (TOF control, n = 32). For each patient, midventricular short-axis and 4-chamber cine steady-state free precession images were analyzed using cardiac magnetic resonance feature-tracking software. Peak left ventricular (LV) and right ventricular (RV) global circumferential and longitudinal strain and indexes of dyssynchrony were compared between groups. Compared with the TOF control group, median strain values were significantly lower for the TOF case group for both the LV (circumferential: 17% vs 23%, p = 0.003; longitudinal: 13% vs 18%, p <0.001) and the RV (circumferential: 10% vs 16%, p = 0.001; longitudinal: 11% vs 18%, p <0.001). In a multivariate model including strain and dyssynchrony parameters, RV and LV longitudinal strain were strongly associated with the adverse outcome (p = 0.003 and 0.04, respectively; area under the curve = 0.92). No differences in ventricular dyssynchrony were identified between the groups. In conclusion, patients with TOF in this cohort who experienced adverse outcomes had lower values of all strain parameters than those who did not, and impaired longitudinal strain of both ventricles was strongly associated with adverse clinical outcomes.
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17
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Abstract
Percutaneous implantation of valves is evolving as the most exciting innovation in transcatheter therapeutics. Valve repairs and replacements form an important indication of re-operations after congenital heart operations. Right ventricular outflow tract surgery is common after repair of conditions such as pulmonary atresia with Tetralogy of Fallot, common arterial trunk and Rastelli operation for transposition of great arteries, ventricular septal defect with pulmonary stenosis. Conduit survival is improving, nevertheless, re-operations are common. Although the re-operations can be performed at low risk, they still involve morbidity and mortality. Percutaneous implantation of valves is emerging as an alternative option for these group of patients. Our experience in percutaneous implantation of pulmonary valves has yielded encouraging results. For incompetence, the results are excellent. Evolving technology is making it applicable in wider clinical situations. Similar technology could also be applied to implantation of valves in the aortic position.
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Affiliation(s)
- S Khambadkone
- Cardiac Catheterisation Laboratory, Great Ormond Street Hospital, London, UK
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18
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Kirsch RE, Glatz AC, Gaynor JW, Nicolson SC, Spray TL, Wernovsky G, Bird GL. Results of elective repair at 6 months or younger in 277 patients with tetralogy of Fallot: a 14-year experience at a single center. J Thorac Cardiovasc Surg 2013; 147:713-7. [PMID: 23602127 DOI: 10.1016/j.jtcvs.2013.03.033] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 02/15/2013] [Accepted: 03/20/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report practice and outcomes in infants undergoing elective repair of tetralogy of Fallot. METHODS A review of a retrospective cohort of elective complete repair of infants age 6 months or younger from 1995 to 2009 was performed. Patients were excluded because of previous interventions, hypercyanotic episodes, intensive care admissions, additional major cardiac defects, or if they were not discharged after birth. Length of stay, mortality, and complications were recorded. Association was determined using logistic or linear regression models and univariate testing determined the multivariate model. RESULTS There were 277 patients included. The hospital mortality rate was zero. A total of 87.4% of patients were discharged home within 7 days of repair, and 21.6% of patients were discharged on or before the third postoperative day. The postoperative course was uncomplicated in 245 patients (88.4%). Longer support time was associated independently with increased odds of complications (P < .001). Longer support time, younger age, chromosomal abnormality, and presence of a complication were associated independently with a longer hospital stay (all P < .001). Patients younger than 3 months (n = 110) had a longer median hospital stay (4 vs 3 days; P < .001) and longer support times (77.3 ± 35.1 min vs 66.4 ± 34 min; P < .01). CONCLUSIONS Elective tetralogy of Fallot repair was performed at 6 months or younger with low morbidity, no hospital mortality, and an 11.6% complication rate. Longer support times, lower weight, chromosomal abnormalities, and complications were associated with a significantly increased duration of hospital stay.
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Affiliation(s)
- Roxanne E Kirsch
- Division of Critical Care, Department of Anesthesiology and Critical Care Medicine, Cardiac Center at the Children's Hospital of Philadelphia, Philadelphia, Pa.
| | - Andrew C Glatz
- Division of Cardiology, Department of Pediatrics, Cardiac Center at the Children's Hospital of Philadelphia, Philadelphia, Pa
| | - J William Gaynor
- Division of Cardiothoracic Surgery, Department of Pediatric Surgery, Cardiac Center at the Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Susan C Nicolson
- Division of Critical Care, Department of Anesthesiology and Critical Care Medicine, Cardiac Center at the Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Thomas L Spray
- Division of Cardiothoracic Surgery, Department of Pediatric Surgery, Cardiac Center at the Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Gil Wernovsky
- Division of Critical Care, Department of Anesthesiology and Critical Care Medicine, Cardiac Center at the Children's Hospital of Philadelphia, Philadelphia, Pa; Division of Cardiology, Department of Pediatrics, Cardiac Center at the Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Geoffrey L Bird
- Division of Critical Care, Department of Anesthesiology and Critical Care Medicine, Cardiac Center at the Children's Hospital of Philadelphia, Philadelphia, Pa; Division of Cardiology, Department of Pediatrics, Cardiac Center at the Children's Hospital of Philadelphia, Philadelphia, Pa
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19
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Friedberg MK, Fernandes FP, Roche SL, Slorach C, Grosse-Wortmann L, Manlhiot C, Fackoury C, McCrindle BW, Mertens L, Kantor PF. Relation of right ventricular mechanics to exercise tolerance in children after tetralogy of Fallot repair. Am Heart J 2013; 165:551-7. [PMID: 23537972 DOI: 10.1016/j.ahj.2012.06.029] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 06/23/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Progressive right ventricular (RV) dysfunction and exercise intolerance are common problems after tetralogy of Fallot (TOF) repair. We investigated RV myocardial deformation and dyssynchrony in children after TOF repair and their association with exercise capacity. METHODS Asymptomatic children after TOF repair were investigated by 2-dimensional speckle tracking echocardiography, magnetic resonance, and metabolic exercise study. Patients with RV outflow obstruction were excluded. Peak RV longitudinal strain and strain rate (SR) and dyssynchrony (RV intraventricular delay) were compared with healthy controls. Associations between RV strain, dyssynchrony, and exercise capacity were analyzed. RESULTS Thirty-nine (81%) of 48 TOF patients and 40 healthy controls had adequate RV strain imaging. The TOF patients had moderately dilated RVs and normal RV ejection fraction. Right ventricular peak systolic strain (-23.2% ± 5.1% vs -28.5% ± 8.5%, P < .001) and SR (-1.46 ± 0.68 vs -2.1 ± 0.8, P < .001) were reduced in TOF patients compared with controls. Right ventricular intraventricular delay was higher in TOF patients (146.0 ± 159 vs 71.0 ± 92 milliseconds, P = .008). Decreased RV strain and SR were associated with increased RV dyssynchrony (strain parameter estimate [PE] 6.31 [2.30], P = .007; SR [PE] 11.32 [3.84], P = .004). Increased RV-left ventricular delay was associated with prolonged QRS duration (PE 0.13 [0.058], P = .03) and reduced RV ejection fraction (PE -2.95 [1.275], P = .02). Reduced RV peak SR was associated with decreased exercise peak oxygen uptake (PE 0.14 [0.07], P = .04). CONCLUSIONS After repair of TOF, asymptomatic children have reduced RV deformation in association with RV dyssynchrony and reduced exercise tolerance.
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Bakhtiary F, Dähnert I, Leontyev S, Schröter T, Hambsch J, Mohr FW, Kostelka M. Outcome and Incidence of Re-Intervention After Surgical Repair of Tetralogy of Fallot. J Card Surg 2012. [DOI: 10.1111/jocs.12030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Farhad Bakhtiary
- Department of Cardiac Surgery; University of Leipzig, Heart Centre; Leipzig Germany
| | - Ingo Dähnert
- Department of Paediatric Cardiology; University of Leipzig, Heart Centre; Leipzig Germany
| | - Sergey Leontyev
- Department of Cardiac Surgery; University of Leipzig, Heart Centre; Leipzig Germany
| | - Thomas Schröter
- Department of Cardiac Surgery; University of Leipzig, Heart Centre; Leipzig Germany
| | - Jörg Hambsch
- Department of Paediatric Cardiology; University of Leipzig, Heart Centre; Leipzig Germany
| | | | - Martin Kostelka
- Department of Cardiac Surgery; University of Leipzig, Heart Centre; Leipzig Germany
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Silvilairat S, Wongsathikun J, Sittiwangkul R, Pongprot Y, Chattipakorn N. Heart rate variability and exercise capacity of patients with repaired tetralogy of Fallot. Pediatr Cardiol 2011; 32:1158-63. [PMID: 21739302 DOI: 10.1007/s00246-011-0040-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 06/16/2011] [Indexed: 01/29/2023]
Abstract
Heart rate variability (HRV) has been used as a reliable method to detect cardiac autonomic nervous system activity. Peak oxygen uptake (VO(2) peak) has been a predictor of death for adults with repaired tetralogy of Fallot (TOF). This study investigated the correlation between HRV and exercise capacity in 30 patients with TOF after surgery for total correction. The median age of the patients was 14 years (range, 9-25 years), and the median follow-up period was 11.6 months (range, 5.3-20.2 months). Low- and high-frequency-domain HRV significantly correlated with VO(2) peak (r = 0.56, P = 0.001 and r = 0.44, P = 0.02, respectively). After the 1-year follow-up evaluation, VO(2) peak and HRV analysis did not differ from those at entry to the study. However, low- and high-frequency-domain HRV still correlated significantly with VO(2) peak (r = 0.43, P = 0.03 and r = 0.52, P = 0.007, respectively). Left ventricular early diastolic myocardial velocity was most closely correlated with the VO(2) peak (r = 0.51, P = 0.005). Impaired cardiovascular autonomic control and left ventricular diastolic dysfunction may be responsible for exercise intolerance in patients with repaired TOF. Long-term follow-up evaluation with exercise testing and 24-h Holter monitoring are warranted.
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Affiliation(s)
- Suchaya Silvilairat
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
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Silvilairat S, Wongsathikun J, Sittiwangkul R, Pongprot Y, Chattipakorn N. Effects of left ventricular function on the exercise capacity in patients with repaired tetralogy of Fallot. Echocardiography 2011; 28:1019-24. [PMID: 21929568 DOI: 10.1111/j.1540-8175.2011.01499.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Tissue Doppler imaging has been recently used to evaluate ventricular function. Peak oxygen uptake (V•O2peak) has been demonstrated as a predictor for death in adults with repaired tetralogy of Fallot (TOF). The aim of this study was to determine which Doppler parameters correlated with V•O2peak in patients with repaired TOF. METHOD AND RESULTS Doppler echocardiography, tissue Doppler imaging, and exercise test were performed in 30 patients with TOF after surgical repair. In 30 patients with repaired TOF (median age 14 years, range 9-25 years), 11 patients (37%) were female. Seven patients (median age 12 years) had normal left ventricular diastolic function, whereas the rest of the patients were classified as diastolic dysfunction grade II (median age 15 years; n=15) and III and IV (median age 18 years; n=8). The oxygen uptake at anaerobic threshold (V•O2AT) and peak exercise in patients with left ventricular diastolic dysfunction was significantly lower than that in those with normal diastolic function. Also, V•O2AT and V•O2 peak in patients with diastolic dysfunction grade III and IV were significantly lower than that in those with diastolic dysfunction grade II. Left ventricular early diastolic myocardial velocity was most closely correlated to V•O2peak (r=0.51; P=0.005). Peak early ventricular filling velocity to early diastolic myocardial velocity ratio was significantly correlated with V•O2peak (r=-0.50; P=0.006). CONCLUSION Left ventricular diastolic dysfunction is correlated with V•O2peak. Left ventricular diastolic function should be a routine echocardiographic assessment in patients with repaired TOF.
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Affiliation(s)
- Suchaya Silvilairat
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Valverde I, Parish V, Tzifa A, Head C, Sarikouch S, Greil G, Schaeffter T, Razavi R, Beerbaum P. Cardiovascular MR dobutamine stress in adult tetralogy of fallot: Disparity between CMR volumetry and flow for cardiovascular function. J Magn Reson Imaging 2011; 33:1341-50. [DOI: 10.1002/jmri.22573] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Ortega M, Triedman JK, Geva T, Harrild DM. Relation of left ventricular dyssynchrony measured by cardiac magnetic resonance tissue tracking in repaired tetralogy of fallot to ventricular tachycardia and death. Am J Cardiol 2011; 107:1535-40. [PMID: 21414597 DOI: 10.1016/j.amjcard.2011.01.032] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2010] [Revised: 01/06/2011] [Accepted: 01/06/2011] [Indexed: 12/28/2022]
Abstract
The impact of left ventricular (LV) dyssynchrony on clinical outcomes in patients with tetralogy of Fallot (TOF) is unknown. The aim of this study was to test the hypothesis that LV dyssynchrony assessed by cardiac magnetic resonance (CMR)-derived tissue tracking in patients with repaired TOF is associated with ventricular tachycardia (VT) and death. Included patients had repaired TOF and CMR data from 2000 and 2008. Patients (n = 13) had histories of death or sustained VT. Control subjects (n = 26), with no death or VT, were matched by age at CMR and type of last surgical procedure. Demographic, clinical, and electrocardiographic data were recorded. CMR short-axis cine data were analyzed by tracking the motion of the endocardial border using commercial software. LV dyssynchrony was quantified as the maximum difference in time to peak radial displacement, circumferential strain, and radial strain among the 6 ventricular segments and the standard deviation of the times to peak value. There were no differences between groups in clinical, electrocardiographic, or demographic characteristics. Among CMR parameters, right ventricular volumes were higher and ejection fractions lower in the patient group. Indexes of LV dyssynchrony were higher in the patient group (e.g., maximum time difference of circumferential strain 94 vs 46 ms, p <0.001; standard deviation of circumferential strain 37.8 vs 20.3 ms, p <0.01). In a multivariate model including LV synchrony variables, the best outcome discriminator was maximum time difference to peak circumferential strain (p <0.01). In conclusion, tissue tracking applied to CMR images identifies indexes of LV synchrony associated with death and VT in patients with repaired TOF.
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Geva T. Repaired tetralogy of Fallot: the roles of cardiovascular magnetic resonance in evaluating pathophysiology and for pulmonary valve replacement decision support. J Cardiovasc Magn Reson 2011; 13:9. [PMID: 21251297 PMCID: PMC3036629 DOI: 10.1186/1532-429x-13-9] [Citation(s) in RCA: 369] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 01/20/2011] [Indexed: 11/10/2022] Open
Abstract
Surgical management of tetralogy of Fallot (TOF) results in anatomic and functional abnormalities in the majority of patients. Although right ventricular volume load due to severe pulmonary regurgitation can be tolerated for many years, there is now evidence that the compensatory mechanisms of the right ventricular myocardium ultimately fail and that if the volume load is not eliminated or reduced by pulmonary valve replacement the dysfunction might be irreversible. Cardiovascular magnetic resonance (CMR) has evolved during the last 2 decades as the reference standard imaging modality to assess the anatomic and functional sequelae in patients with repaired TOF. This article reviews the pathophysiology of chronic right ventricular volume load after TOF repair and the risks and benefits of pulmonary valve replacement. The CMR techniques used to comprehensively evaluate the patient with repaired TOF are reviewed and the role of CMR in supporting clinical decisions regarding pulmonary valve replacement is discussed.
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Affiliation(s)
- Tal Geva
- Department of Cardiology, Children's Hospital Boston, Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
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Abstract
There has been a steady rise in the prevalence of severe congenital heart disease (CHD) in adults because of improved treatment and survival during childhood. This has resulted in a shift in CHD morbidity and mortality beyond 18 years of age. The healthcare community must be prepared to meet this new challenge. Adult cardiologists need to be aware of common CHD, such as tetralogy of Fallot (TOF), as they will encounter adults with this CHD in their practice. With routine monitoring, cardiac imaging, early intervention, and treatment as highlighted in this report, continued improvement in the long-term fitness and avoidance of late complications for adult TOF patient is anticipated.
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Affiliation(s)
- Nishant Kalra
- Division of Cardiology, Department of Internal Medicine, University of Arizona, Tucson, AZ 85724, USA.
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Farah MCK, Castro CRP, Moreira VDM, Binotto MA, Guerra VC, Riso ADA, Marcial MB, Lopes AA, Mathias W, Aiello VD. The Impact of Preexisting Myocardial Remodeling on Ventricular Function Early after Tetralogy of Fallot Repair. J Am Soc Echocardiogr 2010; 23:912-8. [PMID: 20650609 DOI: 10.1016/j.echo.2010.06.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Indexed: 11/28/2022]
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Park CS, Kim WH, Kim GB, Bae EJ, Kim JT, Lee JR, Kim YJ. Symptomatic Young Infants with Tetralogy of Fallot: One-stage versus Staged Repair. J Card Surg 2010; 25:394-9. [DOI: 10.1111/j.1540-8191.2010.01053.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yerebakan C, Klopsch C, Niefeldt S, Zeisig V, Vollmar B, Liebold A, Sandica E, Steinhoff G. Acute and chronic response of the right ventricle to surgically induced pressure and volume overload – an analysis of pressure–volume relations☆. Interact Cardiovasc Thorac Surg 2010; 10:519-25. [DOI: 10.1510/icvts.2009.221234] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Pillutla P, Shetty KD, Foster E. Mortality associated with adult congenital heart disease: Trends in the US population from 1979 to 2005. Am Heart J 2009; 158:874-9. [PMID: 19853711 DOI: 10.1016/j.ahj.2009.08.014] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Accepted: 08/12/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Significant advances over the last 5 decades have allowed most patients with congenital heart disease to survive well past childhood and into adulthood. Population-based data from the United States are limited regarding mortality in adult survivors. METHODS We used the Center for Disease Control Multiple Cause-of-Death registry to determine trends in mortality from 1979 to 2005 among individuals with congenital heart disease in the United States. RESULTS There were significant reductions in death rates for adults with a number of congenital defects including ventricular septal defect, patent ductus arteriosus, coarctation of the aorta, and Ebstein anomaly. Notably, when all ages were analyzed, there was a 71% decline in deaths associated with transposition of the great arteries (P = .001) and a 40% reduction in deaths associated with tetralogy of Fallot (P < .001). Mortality related to other lesions declined as well. Among adults with cyanotic lesions, the primary contributing cause of death was arrhythmia followed by heart failure. For adults with noncyanotic lesions, the major contributing cause before 1990 was arrhythmia; after 1990, myocardial infarction became the leading contributing cause of death. There was an overall decrease in the incidence of arrhythmia as the cause of death in all ages, particularly among children. CONCLUSIONS Patients with congenital heart disease are living longer. Arrhythmia remains the primary contributing cause of death for those with cyanotic lesions. Myocardial infarction is now the leading contributing cause for adults with noncyanotic congenital heart disease consistent with late survival and an increasing impact of acquired heart disease.
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Affiliation(s)
- Priya Pillutla
- Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
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Yerebakan C, Sandica E, Prietz S, Klopsch C, Ugurlucan M, Kaminski A, Abdija S, Lorenzen B, Boltze J, Nitzsche B, Egger D, Barten M, Furlani D, Ma N, Vollmar B, Liebold A, Steinhoff G. Autologous umbilical cord blood mononuclear cell transplantation preserves right ventricular function in a novel model of chronic right ventricular volume overload. Cell Transplant 2009; 18:855-68. [PMID: 19500473 DOI: 10.3727/096368909x471170] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
We aimed to evaluate the feasibility and efficacy of autologous umbilical cord blood mononuclear cell (UCMNC) transplantation on right ventricular (RV) function in a novel model of chronic RV volume overload. Four-month-old sheep (n = 20) were randomized into cell (n = 10) and control groups (n = 10). After assessment of baseline RV function by the conductance catheter method, a transannular patch (TAP) was sutured to the right ventricular outflow tract (RVOT). Following infundibulotomy the ring of the pulmonary valve was transected without cardiopulmonary bypass. UCMNC implantation (8.22 +/- 6.28 x 10(7)) in the cell group and medium injection in the control group were performed into the RV myocardium around the TAP. UCMNCs were cultured for 2 weeks after fluorescence-activated cell sorting (FACS) analysis for CD34 antigen. Transthoracic echocardiography (TTE) and computed tomography were performed after 6 weeks and 3 months, respectively. RV function was assessed 3 months postoperatively before the hearts were excised for immunohistological examinations. FACS analysis revealed 1.2 +/- 0.22% CD34(+) cells within the isolated UCMNCs from which AcLDL(+) endothelial cells were cultured in vitro. All animals survived surgery. TTE revealed grade II-III pulmonary regurgitation in both groups. Pressure-volume loops under dobutamine stress showed significantly improved RV diastolic function in the cell group (dP/dt(min): p = 0.043; E(ed): p = 0.009). CD31 staining indicated a significantly enhanced number of microvessels in the region of UCMNC implantation in the cell group (p < 0.001). No adverse tissue changes were observed. TAP augmentation and pulmonary annulus distortion without cardiopulmonary bypass constitutes a valid large animal model mimicking the surgical repair of tetralogy of Fallot. Our results indicate that the chronically volume-overloaded RV profits from autologous UCMNC implantation by enhanced diastolic properties with a probable underlying mechanism of increased angiogenesis.
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Affiliation(s)
- Can Yerebakan
- Department of Cardiac Surgery, Medical Faculty, University of Rostock, Rostock, Germany.
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Abstract
Tetralogy of Fallot is a congenital cardiac malformation that consists of an interventricular communication, also known as a ventricular septal defect, obstruction of the right ventricular outflow tract, override of the ventricular septum by the aortic root, and right ventricular hypertrophy. This combination of lesions occurs in 3 of every 10,000 live births, and accounts for 7-10% of all congenital cardiac malformations. Patients nowadays usually present as neonates, with cyanosis of varying intensity based on the degree of obstruction to flow of blood to the lungs. The aetiology is multifactorial, but reported associations include untreated maternal diabetes, phenylketonuria, and intake of retinoic acid. Associated chromosomal anomalies can include trisomies 21, 18, and 13, but recent experience points to the much more frequent association of microdeletions of chromosome 22. The risk of recurrence in families is 3%. Useful diagnostic tests are the chest radiograph, electrocardiogram, and echocardiogram. The echocardiogram establishes the definitive diagnosis, and usually provides sufficient information for planning of treatment, which is surgical. Approximately half of patients are now diagnosed antenatally. Differential diagnosis includes primary pulmonary causes of cyanosis, along with other cyanotic heart lesions, such as critical pulmonary stenosis and transposed arterial trunks. Neonates who present with ductal-dependent flow to the lungs will receive prostaglandins to maintain ductal patency until surgical intervention is performed. Initial intervention may be palliative, such as surgical creation of a systemic-to-pulmonary arterial shunt, but the trend in centres of excellence is increasingly towards neonatal complete repair. Centres that undertake neonatal palliation will perform the complete repair at the age of 4 to 6 months. Follow-up in patients born 30 years ago shows a rate of survival greater than 85%. Chronic issues that now face such adults include pulmonary regurgitation, recurrence of pulmonary stenosis, and ventricular arrhythmias. As the strategies for surgical and medical management have progressed, the morbidity and mortality of those born with tetralogy of Fallot in the current era is expected to be significantly improved.
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Affiliation(s)
- Frederique Bailliard
- North Carolina Children's Heart Center, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Abstract
Tetralogy of Fallot is a congenital cardiac malformation that consists of an interventricular communication, also known as a ventricular septal defect, obstruction of the right ventricular outflow tract, override of the ventricular septum by the aortic root, and right ventricular hypertrophy. This combination of lesions occurs in 3 of every 10,000 live births, and accounts for 7-10% of all congenital cardiac malformations. Patients nowadays usually present as neonates, with cyanosis of varying intensity based on the degree of obstruction to flow of blood to the lungs. The aetiology is multifactorial, but reported associations include untreated maternal diabetes, phenylketonuria, and intake of retinoic acid. Associated chromosomal anomalies can include trisomies 21, 18, and 13, but recent experience points to the much more frequent association of microdeletions of chromosome 22. The risk of recurrence in families is 3%. Useful diagnostic tests are the chest radiograph, electrocardiogram, and echocardiogram. The echocardiogram establishes the definitive diagnosis, and usually provides sufficient information for planning of treatment, which is surgical. Approximately half of patients are now diagnosed antenatally. Differential diagnosis includes primary pulmonary causes of cyanosis, along with other cyanotic heart lesions, such as critical pulmonary stenosis and transposed arterial trunks. Neonates who present with ductal-dependent flow to the lungs will receive prostaglandins to maintain ductal patency until surgical intervention is performed. Initial intervention may be palliative, such as surgical creation of a systemic-to-pulmonary arterial shunt, but the trend in centres of excellence is increasingly towards neonatal complete repair. Centres that undertake neonatal palliation will perform the complete repair at the age of 4 to 6 months. Follow-up in patients born 30 years ago shows a rate of survival greater than 85%. Chronic issues that now face such adults include pulmonary regurgitation, recurrence of pulmonary stenosis, and ventricular arrhythmias. As the strategies for surgical and medical management have progressed, the morbidity and mortality of those born with tetralogy of Fallot in the current era is expected to be significantly improved.
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Affiliation(s)
- Frederique Bailliard
- North Carolina Children's Heart Center, Department of Pediatrics, University of North Carolina at Chapel Hill, USA
| | - Robert H Anderson
- North Carolina Children's Heart Center, Department of Pediatrics, University of North Carolina at Chapel Hill, USA
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
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Hung JH, Lu JH, Weng ZC, Chen CY, Chao KC, Hung CYS. Prenatal diagnosis of tetralogy of Fallot with pulmonary atresia. J Chin Med Assoc 2008; 71:262-6. [PMID: 18490232 DOI: 10.1016/s1726-4901(08)70118-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Tetralogy of Fallot involves an abnormal embryological development in which an unequal conotruncal division results in a small pulmonary artery and a great aortic artery. In its most severe form, the infundibulum of the right ventricle and the pulmonary artery can be atretic with the anomaly commonly referred to as pulmonary atresia with ventricular septal defect. Reported here is a case of prenatal diagnosis of tetralogy of Fallot with pulmonary atresia. The characteristic ultrasonographic findings included a small pulmonary artery, a large aorta, and a ventricular septal defect. The search for an atretic pulmonary valve and a ductus arteriosus with reversed blood flow was emphasized in the presence of asymmetrically dilated fetal heart. After birth, the newborn received single-stage total correction for the tetralogy of Fallot and was discharged a month later in stable condition. In this case report, the neonatal angiogram is added for confirming the prenatal diagnosis, which is of value in teaching fetal echocardiography to novice practitioners. We believe a prenatal diagnosis of tetralogy of Fallot can improve neonatal outcome.
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Affiliation(s)
- Jeng-Hsiu Hung
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan, ROC.
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Graham TP, Bernard Y, Arbogast P, Thapa S, Cetta F, Child J, Chugh R, Davidson W, Hurwitz R, Kay J, Sanders S, Schaufelberger M. Outcome of Pulmonary Valve Replacements in Adults after Tetralogy Repair: A Multi-institutional Study. CONGENIT HEART DIS 2008; 3:162-7. [DOI: 10.1111/j.1747-0803.2008.00189.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Graham EM, Bandisode VM, Bradley SM, Crawford FA, Simsic JM, Atz AM. Effect of preoperative use of propranolol on postoperative outcome in patients with tetralogy of Fallot. Am J Cardiol 2008; 101:693-5. [PMID: 18308023 DOI: 10.1016/j.amjcard.2007.10.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Revised: 10/05/2007] [Accepted: 10/05/2007] [Indexed: 11/16/2022]
Abstract
The aim of this study was to determine if preoperative propranolol therapy has a deleterious effect on postoperative variables in patients with tetralogy of Fallot. Data from 97 patients who underwent complete repair of tetralogy of Fallot were reviewed. The patients were divided into 2 groups: those receiving preoperative propranolol therapy (n = 32) and those not receiving therapy (n = 65). Preoperative and intraoperative variables did not differ between groups. There were no differences in postoperative inotrope scores on arrival to the intensive care unit and through the first 12 hours postoperatively. There was a trend toward increased inotrope scores at 24 hours (median 8 vs 5, p = 0.05) and 48 hours (median 8 vs 3, p = 0.05) postoperatively in the patients treated with propranolol. Temporary pacing in the early postoperative period occurred more often in the propranolol group (16% vs 3%, p = 0.04). There was no difference between groups in length of mechanical ventilation, intensive care unit stay, or total hospital postoperative stay. In conclusion, propranolol therapy can be used in patients with tetralogy of Fallot until the time of surgery, without important effects on their postoperative courses. Any blunting of inotropic or chronotropic activity in propranolol-treated patients appears to be easily overcome with increased inotropic medications or temporary pacing, without increased morbidity or mortality.
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Affiliation(s)
- Eric M Graham
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, USA.
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Cannesson M, Piriou V, Neidecker J, Lehot JJ. Anesthésie pour chirurgie non cardiaque chez le patient adulte porteur d'une cardiopathie congénitale. ACTA ACUST UNITED AC 2007; 26:931-42. [DOI: 10.1016/j.annfar.2007.07.082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Accepted: 07/25/2007] [Indexed: 11/27/2022]
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van den Berg J, Wielopolski PA, Meijboom FJ, Witsenburg M, Bogers AJJC, Pattynama PMT, Helbing WA. Diastolic Function in Repaired Tetralogy of Fallot at Rest and during Stress: Assessment with MR Imaging. Radiology 2007; 243:212-9. [PMID: 17293573 DOI: 10.1148/radiol.2431060213] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively assess, with magnetic resonance (MR) imaging, right ventricular (RV) diastolic function after repair of tetralogy of Fallot (TOF) at rest and during pharmacologic stress and to study relationship between main pulmonary artery end-diastolic forward flow (EDFF) (indicative of restrictive RV physiology) and clinical status. MATERIALS AND METHODS Institutional medical ethics committee approval and patient or parent informed consent were obtained. Patients with TOF corrected through the transatrial-transpulmonary approach underwent MR imaging at rest and during dobutamine stress and maximal exercise testing. Two-dimensional (2D) cine volumetric data were acquired. Flow measurements were performed with a standard 2D flow-sensitized sequence. MR imaging flow curves for tricuspid and pulmonary valves were combined into RV time-volume change curves, from which indexes of RV filling were derived. Patient results were compared with published data in control subjects. Student t tests, Mann-Whitney U tests, analysis of covariance, and paired and one-sample t tests were used. RESULTS Thirty-six patients (mean age at repair, 0.9 year +/- 0.5 [standard deviation]; median age at study inclusion, 17 years [range, 7-23 years]; 26 male and 10 female patients) were included. Abnormalities in RV filling included impaired relaxation (prolonged deceleration time, P = .002; smaller early filling fraction, P = .02) in the entire group compared with published data in healthy control subjects and signs of restriction to RV filling (smaller atrial filling fraction and higher early filling/atrial filling peak ratio, P < .05 for both) in patients with EDFF (n = 24) compared with patients without EDFF (n = 12). Stress response was abnormal in patients with EDFF, who developed impaired RV relaxation not appreciated at rest. Patients with EDFF had more severe pulmonary regurgitation (P < .05) and poorer exercise performance (P < .001). CONCLUSION In patients with TOF corrected with currently widely accepted surgical strategies, pulmonary artery EDFF relates to worse clinical state at mid- to long-term follow-up. Dobutamine stress imaging may unmask abnormalities in RV diastolic filling not appreciated with rest imaging alone.
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Affiliation(s)
- Jochem van den Berg
- Department of Pediatric Cardiology, Sophia Children's Hospital, Erasmus Medical Center, Dr Molewaterplein 60, 3015 GJ Rotterdam, the Netherlands
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van den Berg J, Hop WC, Strengers JLM, de Jongste JC, van Osch-Gevers L, Meijboom FJ, Pattynama PMT, Bogers AJJC, Helbing WA. Clinical condition at mid-to-late follow-up after transatrial-transpulmonary repair of tetralogy of Fallot. J Thorac Cardiovasc Surg 2007; 133:470-7. [PMID: 17258585 DOI: 10.1016/j.jtcvs.2006.10.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Revised: 09/28/2006] [Accepted: 10/09/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To assess the clinical condition at mid-to-late follow-up in tetralogy of Fallot corrected by a transatrial-transpulmonary approach at a young age and to identify risk factors associated with right ventricular dilation/dysfunction and with decreased exercise tolerance. METHODS Patients with tetralogy of Fallot underwent cardiac magnetic resonance imaging, maximal bicycle ergometry, electrocardiography, Holter monitoring, and spirometry. Multivariate linear regression analyses were used to determine independent predictors for selected clinical parameters. RESULTS Fifty-nine patients (mean +/- SD), age at repair 0.9 +/- 0.5 years, interval since repair 14 +/- 5 years, were included. The median pulmonary regurgitant fraction was 32% (0%-57%). Compared with published data on healthy controls, Fallot patients had significantly larger right ventricular end-diastolic and end-systolic volumes and smaller right ventricular and left ventricular ejection fractions. Maximum oxygen consumption was 97% +/- 17% and maximum workload 89% +/- 13% of predicted. Median QRS duration was 110 ms (82-161 ms). No important ventricular arrhythmias were found. Compared with patients without a transannular patch, patients with a patch had more pulmonary regurgitation, a larger right ventricle, worse right ventricular and left ventricular ejection fractions, but comparable exercise capacity. Multivariate regression analysis identified the following independent determinants for larger right ventricular volumes: longer interval since repair, longer QRS duration, and higher pulmonary regurgitation percentage. The following were independent determinants for smaller right ventricular ejection fraction: abnormal right ventricular outflow tract wall motion, longer interval since repair, and longer QRS duration. For smaller maximum oxygen consumption, the independent determinants were smaller right ventricular ejection fraction and longer QRS duration. CONCLUSIONS At mid-to-late follow-up, clinical condition in tetralogy of Fallot corrected according to contemporary surgical approaches appears well preserved. However, even these patients show right ventricular dilation and dysfunction associated with impaired functional capacity. Abnormalities relate to right ventricular outflow tract motion abnormalities, longer interval since repair, longer QRS duration, and more severe pulmonary regurgitation.
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Ooi A, Moorjani N, Baliulis G, Keeton BR, Salmon AP, Monro JL, Haw MP. Medium term outcome for infant repair in tetralogy of Fallot: Indicators for timing of surgery. Eur J Cardiothorac Surg 2006; 30:917-22. [PMID: 17052914 DOI: 10.1016/j.ejcts.2006.08.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2005] [Revised: 08/14/2006] [Accepted: 08/24/2006] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To assess the impact of early corrective surgery on the short and medium term outcome in tetralogy of Fallot (TOF). MATERIALS AND METHODS All patients under 12 months of age undergoing correction of isolated TOF between February 1997 and July 2003 were reviewed retrospectively. Outcome data for mortality, post-operative care management, major morbidity and clinical follow-up were analysed. RESULTS Fifty-two operations were performed. The mean age at surgery was 5 months (range 1-12) of whom 16 (30.8%) were less than 3 months old, including 2 neonates, 22 (42.3%) were 3-6 months old and 14 (26.9%) were 7-12 months old. There was 1 (1.9%) early death caused by a cerebro-vascular accident and 1 (1.9%) late death secondary to acute infective endocarditis. There were no differences in post-operative morbidities attributable to age. Patients under 3 months old required greater duration of post-operative ventilation, ITU stay and in-hospital stay. At a mean follow-up of 4.0 years (range 1.5-8.0), 33 (63.5%) patients had well-tolerated pulmonary regurgitation (PR) and 3 (5.8%) patients required re-operation for right ventricular outflow tract obstruction (RVOTO). All patients had right bundle-branch-block but with QRS < 150 ms. CONCLUSION Early definitive repair of TOF can be performed safely on patients under 6 months old. Age at surgery does not appear to affect the medium term haemodynamic outcome. However, early surgery does escalate the need for ICU care. This data suggests repair in asymptomatic patients be delayed until 3-6 months of age.
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Affiliation(s)
- Adrian Ooi
- Department of Cardiothoracic Surgery, Wessex Cardiothoracic Centre, Southampton University Hospital, Tremona Road, Southampton, United Kingdom.
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Ozkara A, Mert M, Cetin G, Saltik L, Sarioglu T. Right ventricular outflow tract reconstruction for tetralogy of fallot with abnormal coronary artery: experience with 35 patients. J Card Surg 2006; 21:131-6. [PMID: 16492269 DOI: 10.1111/j.1540-8191.2006.00192.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND An abnormal coronary artery crossing the right ventricle outflow tract (RVOT) complicates complete repair of tetralogy of Fallot (TOF). We have evaluated surgical options for RVOT reconstruction for this group of patients. METHODS Between 1984 and 2002, 35 TOF patients with abnormality of coronary arteries underwent total correction. Age of these patients ranged from 1 to 14 years (mean 5.8 +/- 2.8 years). All patients were diagnosed by echocardiography and 25 patients had cardiac catheterization. All the abnormal coronary arteries were spared at the operation. In 24 patients a transannular patch was applied for RVOT reconstruction. In three patients with an adequate pulmonary annulus, oblique ventriculotomy incisions, and in two patients, transatrial approaches were performed. "Two-patch" technique was chosen for two patients. In four patients placement of an extracardiac conduit was necessary. RESULTS Mortality was observed in four patients, in two of them due to suspected myocardial ischemia. None of the surviving patients needed reoperation. All of them were in NYHA class I. The follow-up period for patients without extracardiac conduit was between 14 and 96 months (mean 50.2 months) and for the patients with extracardiac conduit ranged 36 to 98 months (63.5 months). The mean gradients measured by echocardiography were, respectively, 5 mmHg (range 0 to 35 mmHg) and 23.75 mmHg (range 20 to 25 mmHg). CONCLUSIONS Definitive repair of TOF patients with abnormal coronary arteries can be performed in early childhood, but care should be taken to leave at least 1 cm of myocardium between the sutureline and the abnormal coronary artery. Detailed evaluation of the patients preoperatively is mandatory to identify the strategy and timing of the operation.
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Affiliation(s)
- A Ozkara
- Department of Cardiovascular Surgery, Institute of Cardiology, Istanbul University, Turkey.
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Abstract
Surgical management of tetralogy of Fallot results in anatomic and functional abnormalities in the majority of patients. Although right ventricular volume load due to severe pulmonary regurgitation can be tolerated for years, there is now evidence that the compensatory mechanisms of the right ventricular myocardium ultimately fail and that if the volume load is not eliminated or reduced the dysfunction might be irreversible. In light of that data and with better understanding of risk factors for adverse outcomes late after tetralogy of Fallot repair, many centers are now recommending early pulmonary valve replacement before symptoms of heart failure develop. This article reviews the pathophysiology of chronic right ventricular volume load after tetralogy of Fallot repair and the risks and benefits of pulmonary valve replacement. Finally, recommendations for timing and indications for pulmonary valve replacement are given.
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Affiliation(s)
- Tal Geva
- Department of Cardiology, Children's Hospital Boston, Boston, MA 02115, USA.
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Pozzi M, Quarti A, Corno AF. Tetralogy of fallot. Multimed Man Cardiothorac Surg 2006; 2006:mmcts.2005.001487. [PMID: 24413328 DOI: 10.1510/mmcts.2005.001487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The optimal management of patients with tetralogy of Fallot has to consider the individual intra-cardiac anatomy as the most important variable, together with the age and the body weight of the patient. In any case the potential advantages of a primary early repair should be weighted against the experience and expertise of the individual centre and/or surgical team in dealing with tetralogy of Fallot and with neonates and infants. The best results are achieved by very carefully adapting the surgical technique to the individual morphology of the right ventricular outflow tract and of the pulmonary arteries. The details of the established surgical management for each component of the surgical repair are analysed and described. Over a period of 12 years (from 1993 to 2005) 318 consecutive patients with tetralogy of Fallot underwent repair with one hospital death (1/318=0.3% mortality).
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Affiliation(s)
- Marco Pozzi
- Alder Hey Royal Children Hospital, Cardiac Unit, Eaton Road, Liverpool, L12 2AP, UK
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Abstract
In children with pulmonary atresia not amenable to initial complete correction, antegrade pulmonary blood flow can be established with surgical right ventricular outflow tract (RVOT) patch enlargement. An 11-year experience with RVOT transannular patch (TAP) augmentation without the use of cardiopulmonary bypass (off-pump) is reported. From March 1993 to October 2004, off-pump surgical RVOT enlargement with a TAP was attempted in all patients in whom a concurrent procedure that required bypass was not required. The procedure was performed with cardiopulmonary bypass standby. Twenty-two consecutive patients in whom this procedure was attempted were reviewed. Twenty of 22 patients tolerated off-pump TAP placement. In 2 patients with ductal-dependent pulmonary blood flow, off-pump TAP placement was not tolerated. Adequate antegrade pulmonary blood flow was achieved in all patients without operative mortalities or complications. There was one death in the postoperative period from myocardial ischemia secondary to right ventricular-dependent coronary circulation. Transannular RVOT patch augmentation can be performed safely and effectively without cardiopulmonary bypass.
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Affiliation(s)
- D S Levi
- Divisions of Pediatric Cardiology, Mattel Children's Hospital at UCLA, B2-427 MDCC, Los Angeles, CA, 90095-1743, USA.
| | - J P Glotzbach
- Division of Cardiothoracic Surgery, Tulane University Medical School, New Orleans, LA, 70112-2669, USA
| | - R J Williams
- Divisions of Pediatric Cardiology, Mattel Children's Hospital at UCLA, B2-427 MDCC, Los Angeles, CA, 90095-1743, USA
| | - J L Myers
- Division of Cardiothoracic Surgery, Tulane University Medical School, New Orleans, LA, 70112-2669, USA
| | - H Laks
- Division of Cardiothoracic Surgery, Mattel Children's Hospital at UCLA, Los Angeles, CA, 90095-1743, USA
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Vettukattil JJ. Is tricuspid valve annuloplasty required in children with right heart obstruction and tricuspid valve regurgitation? Ann Thorac Surg 2005; 81:405. [PMID: 16368423 DOI: 10.1016/j.athoracsur.2005.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2005] [Revised: 03/27/2005] [Accepted: 05/09/2005] [Indexed: 12/01/2022]
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Stewart RD, Backer CL, Young L, Mavroudis C. Tetralogy of Fallot: Results of a Pulmonary Valve-Sparing Strategy. Ann Thorac Surg 2005; 80:1431-8; discussion 1438-9. [PMID: 16181883 DOI: 10.1016/j.athoracsur.2005.04.016] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2005] [Revised: 04/05/2005] [Accepted: 04/06/2005] [Indexed: 11/15/2022]
Abstract
BACKGROUND Our surgical strategy for repair of tetralogy of Fallot has focused on preserving the pulmonary valve. The purpose of this review was to identify pulmonary valve characteristics that mark the limits of this strategy. METHODS From 1997 through 2004, 102 consecutive patients underwent repair of tetralogy of Fallot at a median age of 5.9 months. Twenty-five patients had a prior shunt. Eighty-two patients (80%) had pulmonary valve-sparing procedures, predominantly through a transatrial and transpulmonary approach (n = 52). Twenty patients had a transannular patch (20%). Intraoperative measurements included the pulmonary valve annulus size and the postoperative pressure ratio between the right and left ventricles. RESULTS Eighty of 85 (94%) patients with z-score greater than -4 had a pulmonary valve-sparing procedure compared with 2 of 17 patients (12%) with pulmonary valve annulus z-scores less than -4 (p < 0.0001). All patients with a tricuspid pulmonary valve (n = 26) had a pulmonary valve-sparing procedure compared with 56 of 76 (74%) patients with a bicuspid pulmonary valve (p = 0.0016). Five patients with initial pulmonary valve-sparing operations required reoperation for residual stenoses; 4 pulmonary valve-sparing right ventricular outflow tract resections and 1 transannular patch. The only death occurred after reoperation elsewhere. Three of 9 patients (33%) who had a postoperative pressure ratio between the right and left ventricles greater than 0.7 after their initial pulmonary valve-sparing procedure required reoperation compared with 2 of 73 with postoperative pressure ratio between the right and left ventricles less than 0.7 (3%; p = 0.008). Fifteen of 25 patients (60%) with prior shunts had pulmonary valve-sparing procedures. CONCLUSIONS A pulmonary valve-sparing approach to the repair of tetralogy of Fallot was applied successfully in 80% of patients. Significant markers for success were a measured pulmonary annulus z-score of -4 or larger, a tricuspid pulmonary valve, and a postoperative pressure ratio between the right and left ventricles less than 0.7.
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Affiliation(s)
- Robert D Stewart
- Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Chicago, Illinois 60614, USA
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Giannopoulos NM, Chatzis AC, Bobos DP, Kirvassilis GV, Tsoutsinos A, Sarris GE. Tetralogy of Fallot: influence of right ventricular outflow tract reconstruction on late outcome. Int J Cardiol 2005; 97 Suppl 1:87-90. [PMID: 15590084 DOI: 10.1016/j.ijcard.2004.08.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Surgical repair of Tetralogy of Fallot (TOF) is followed by very good early and medium-term results (perioperative mortality < or =5%), but there is increasing awareness of the occurrence of late adverse events: many patients experience progressive right ventricular (RV) dilatation/dysfunction leading to symptomatic right ventricular failure, arrhythmias, need for reoperation(in 5-15% of patients within 5-20 years after initial correction ), and late death. Although some predisposing factors such as complexity of anatomy (borderline pulmonary artery (PA) size, right ventricular outflow tract (RVOT) hypoplasia), age at operation, or prior shunting appear to affect early or late outcome adversely, it is debatable if other factors such as type of repair or use of a transannular patch correlate with poor late outcome or increased reoperation rates. Obviously, if careful study reveals specific modifiable factors predisposing to adverse late events (e.g. component of surgical technique), appropriate modification in surgical management may lead to improved late outcome.
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Affiliation(s)
- N M Giannopoulos
- Department of Pediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Center, 356 Sygrou Avenue, 176 74 Kallithea, Athens, Greece
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