Original articleCardiovascularTetralogy of Fallot: Results of a Pulmonary Valve-Sparing Strategy
Section snippets
Patients and Methods
Institutional review board approval was obtained for this study.
All patients undergoing repair of TOF between January 1997 and July 2004 at our institution were identified from our computerized patient database. Patients with prior complete repair, TOF with pulmonary atresia, TOF with absent pulmonary valve, and TOF with atrioventricular canal defects were excluded.
Reparative techniques were similar for all patients and included aorto–bicaval cardiopulmonary bypass with moderate hypothermia
Results
There were 102 patients with TOF with pulmonary stenosis repaired during the study period. There were no perioperative deaths. One infant who required reoperation died after surgical revision at another hospital 5 months after the initial procedure. Twenty-five patients had prior systemic-to-pulmonary artery shunts (25%) at a median age of 36 days and a mean weight of 3.5 ± 2.0 kg. There were no deaths among the patients who had a shunt, although 1 patient had a cardiac arrest after a shunt
Comment
This series of patients with TOF with pulmonary stenosis demonstrates that an aggressive approach to subvalvar and supravalvar obstruction with pulmonary valvuloplasty can lead to a very low rate of transannular patching. The pulmonary valve salvage rate of 80% may indeed be an underestimate owing to our experience with the monocusp valve insertion during the first 15 months of this study period. The effort to salvage the pulmonary valve was perhaps less aggressive with the thought of
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