Hostname: page-component-848d4c4894-pftt2 Total loading time: 0 Render date: 2024-06-01T04:38:01.229Z Has data issue: false hasContentIssue false
  • English
  • Français

Surgical pulmonary valve insertion – when, how, and why

Published online by Cambridge University Press:  18 January 2013

Cheul Lee ,
Jeffrey P. Jacobs ,
Chang-Ha Lee ,
Jae Gun Kwak ,
Paul J. Chai  and
James A. Quintessenza
Cheul Lee*
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Cardiovascular Center, Sejong General Hospital, Bucheon, Republic of Korea
Jeffrey P. Jacobs
Affiliation:
Johns Hopkins Children's Heart Surgery, All Children's Hospital and Florida Hospital for Children, Saint Petersburg, Tampa, and Orlando, Florida, United States of America
Chang-Ha Lee
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Cardiovascular Center, Sejong General Hospital, Bucheon, Republic of Korea
Jae Gun Kwak
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Cardiovascular Center, Sejong General Hospital, Bucheon, Republic of Korea
Paul J. Chai
Affiliation:
Johns Hopkins Children's Heart Surgery, All Children's Hospital and Florida Hospital for Children, Saint Petersburg, Tampa, and Orlando, Florida, United States of America
James A. Quintessenza
Affiliation:
Johns Hopkins Children's Heart Surgery, All Children's Hospital and Florida Hospital for Children, Saint Petersburg, Tampa, and Orlando, Florida, United States of America
*
Correspondence to: Dr C. Lee, MD, PhD, Department of Thoracic and Cardiovascular Surgery, Cardiovascular Center, Sejong General Hospital, 91–121 Sosa Bon 2-dong, Sosa-gu, Bucheon, Gyeonggi-do 422–711, Republic of Korea. Tel: +82 32 340 1451; Fax: +82 32 340 1236; E-mail: tscheul@hanmail.net
Get access Rights & Permissions [Opens in a new window]

Abstract

Relief of right ventricular outflow tract obstruction in tetralogy of Fallot or similar physiology often results in pulmonary regurgitation. The resultant chronic volume overload can lead to right ventricular dilatation, biventricular dysfunction, heart failure symptoms, arrhythmias, and sudden death. Although pulmonary valve replacement can lead to improvement in functional class and a substantial decrease or normalisation of right ventricular volumes, the optimal timing of pulmonary valve replacement is not well defined. Benefits of pulmonary valve replacement have to be weighed against the risks of this procedure, including subsequent reoperation. This article will review the benefits and risks of pulmonary valve replacement, options for pulmonary valve substitute, and timing of pulmonary valve replacement in patients with chronic pulmonary regurgitation after relief of right ventricular outflow tract obstruction.

Keywords

Magnetic resonance imagingpulmonary regurgitationpulmonary valve replacementsurgerytetralogy of Fallot
Type
Original Article
Information
Cardiology in the Young , Volume 22 , Issue 6: A Lifelong Interdisciplinary Approach to Common Arterial Trunk, Transposition of the Great Arteries, and Other Evolving Challenges in Paediatric and Congenital Cardiac Disease , December 2012 , pp. 702 - 707
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Murphy, JG, Gersh, BJ, Mair, DD, et al. Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot. N Engl J Med 1993; 329: 593–599.CrossRefGoogle ScholarPubMed
2. Therrien, J, Marx, GR, Gatzoulis, MA. Late problems in tetralogy of Fallot – recognition, management, and prevention. Cardiol Clin 2002; 20: 395–404.CrossRefGoogle ScholarPubMed
3. Gatzoulis, MA, Balaji, S, Webber, SA, et al. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. Lancet 2000; 356: 975–981.CrossRefGoogle ScholarPubMed
4. Geva, T, Sandweiss, BM, Gauvreau, K, Lock, JE, Powell, AJ. Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging. J Am Coll Cardiol 2004; 43: 1068–1074.CrossRefGoogle ScholarPubMed
5. Bouzas, B, Kilner, PJ, Gatzoulis, MA. Pulmonary regurgitation: not a benign lesion. Eur Heart J 2005; 26: 433–439.CrossRefGoogle Scholar
6. Cheung, EW, Wong, WH, Cheung, YF. Meta-analysis of pulmonary valve replacement after operative repair of tetralogy of Fallot. Am J Cardiol 2010; 106: 552–557.CrossRefGoogle ScholarPubMed
7. Geva, T, Gauvreau, K, Powell, AJ, et al. Randomized trial of pulmonary valve replacement with and without right ventricular remodeling surgery. Circulation 2010; 122 (11 Suppl): S201–S208.CrossRefGoogle ScholarPubMed
8. Dave, HH, Buechel, ER, Dodge-Khatami, A, et al. Early insertion of a pulmonary valve for chronic regurgitation helps restoration of ventricular dimensions. Ann Thorac Surg 2005; 80: 1615–1621.CrossRefGoogle ScholarPubMed
9. Oosterhof, T, van Straten, A, Vliegen, HW, et al. Preoperative thresholds for pulmonary valve replacement in patients with corrected tetralogy of Fallot using cardiovascular magnetic resonance. Circulation 2007; 116: 545–551.CrossRefGoogle ScholarPubMed
10. Frigiola, A, Tsang, V, Bull, C, et al. Biventricular response after pulmonary valve replacement for right ventricular outflow tract dysfunction: is age a predictor of outcome? Circulation 2008; 118 (14 Suppl): S182–S190.CrossRefGoogle ScholarPubMed
11. Lim, C, Lee, JY, Kim, WH, et al. Early replacement of pulmonary valve after repair of tetralogy: is it really beneficial? Eur J Cardiothorac Surg 2004; 25: 728–734.CrossRefGoogle ScholarPubMed
12. Scherptong, RW, Hazekamp, MG, Mulder, BJ, et al. Follow-up after pulmonary valve replacement in adults with tetralogy of Fallot: association between QRS duration and outcome. J Am Coll Cardiol 2010; 56: 1486–1492.CrossRefGoogle ScholarPubMed
13. Ghez, O, Tsang, VT, Frigiola, A, et al. Right ventricular outflow tract reconstruction for pulmonary regurgitation after repair of tetralogy of Fallot. Preliminary results. Eur J Cardiothorac Surg 2007; 31: 654–658.CrossRefGoogle ScholarPubMed
14. Therrien, J, Provost, Y, Merchant, N, Williams, W, Colman, J, Webb, G. Optimal timing for pulmonary valve replacement in adults after tetralogy of Fallot repair. Am J Cardiol 2005; 95: 779–782.CrossRefGoogle ScholarPubMed
15. Frigiola, A, Giamberti, A, Chessa, M, et al. Right ventricular restoration during pulmonary valve implantation in adults with congenital heart disease. Eur J Cardiothorac Surg 2006; 29 (Suppl 1): S279–S285.CrossRefGoogle ScholarPubMed
16. Harrild, DM, Berul, CI, Cecchin, F, et al. Pulmonary valve replacement in tetralogy of Fallot: impact on survival and ventricular tachycardia. Circulation 2009; 119: 445–451.CrossRefGoogle ScholarPubMed
17. Vliegen, HW, van Straten, A, de Roos, A, et al. Magnetic resonance imaging to assess the hemodynamic effects of pulmonary valve replacement in adults late after repair of tetralogy of Fallot. Circulation 2002; 106: 1703–1707.CrossRefGoogle ScholarPubMed
18. Therrien, J, Siu, SC, Harris, L, et al. Impact of pulmonary valve replacement on arrhythmia propensity late after repair of tetralogy of Fallot. Circulation 2001; 103: 2489–2494.CrossRefGoogle ScholarPubMed
19. Doughan, AR, McConnell, ME, Lyle, TA, Book, WM. Effects of pulmonary valve replacement on QRS duration and right ventricular cavity size late after repair of right ventricular outflow tract obstruction. Am J Cardiol 2005; 95: 1511–1514.CrossRefGoogle ScholarPubMed
20. Gengsakul, A, Harris, L, Bradley, TJ, et al. The impact of pulmonary valve replacement after tetralogy of Fallot repair: a matched comparison. Eur J Cardiothorac Surg 2007; 32: 462–468.CrossRefGoogle ScholarPubMed
21. Dos, L, Dadashev, A, Tanous, D, et al. Pulmonary valve replacement in repaired tetralogy of Fallot: determinants of early postoperative adverse outcomes. J Thorac Cardiovasc Surg 2009; 138: 553–559.CrossRefGoogle ScholarPubMed
22. Borger, MA, Ivanov, J, Armstrong, S, Christie-Hrybinsky, D, Feindel, CM, David, TE. Twenty-year results of the Hancock II bioprosthesis. J Heart Valve Dis 2006; 15: 49–55.Google ScholarPubMed
23. McClure, RS, Narayanasamy, N, Wiegerinck, E, et al. Late outcomes for aortic valve replacement with the Carpentier-Edwards pericardial bioprosthesis: up to 17-year follow-up in 1,000 patients. Ann Thorac Surg 2010; 89: 1410–1416.CrossRefGoogle Scholar
24. Discigil, B, Dearani, JA, Puga, FJ, et al. Late pulmonary valve replacement after repair of tetralogy of Fallot. J Thorac Cardiovasc Surg 2001; 121: 344–351.CrossRefGoogle ScholarPubMed
25. Caldarone, CA, McCrindle, BW, Van Arsdell, GS, et al. Independent factors associated with longevity of prosthetic pulmonary valves and valved conduits. J Thorac Cardiovasc Surg 2000; 120: 1022–1031.CrossRefGoogle ScholarPubMed
26. Konakci, KZ, Bohle, B, Blumer, R, et al. Alpha-Gal on bioprostheses: xenograft immune response in cardiac surgery. Eur J Clin Invest 2005; 35: 17–23.CrossRefGoogle ScholarPubMed
27. Manji, RA, Zhu, LF, Nijjar, NK, et al. Glutaraldehyde-fixed bioprosthetic heart valve conduits calcify and fail from xenograft rejection. Circulation 2006; 114: 318–327.CrossRefGoogle ScholarPubMed
28. Lee, C, Ahn, H, Kim, SH, Choi, SY, Kim, YJ. Immune response to bovine pericardium implanted into α1,3-galactosyltransferase knockout mice: feasibility as an animal model for testing efficacy of anticalcification treatments of xenografts. Eur J Cardiothorac Surg 2012; 42: 164–172.CrossRefGoogle ScholarPubMed
29. Lee, C, Park, CS, Lee, CH, et al. Durability of bioprosthetic valves in the pulmonary position: long-term follow-up of 181 implants in patients with congenital heart disease. J Thorac Cardiovasc Surg 2011; 142: 351–358.CrossRefGoogle ScholarPubMed
30. van de Woestijne, PC, Mokhles, MM, de Jong, PL, Witsenburg, M, Takkenberg, JJ, Bogers, AJ. Right ventricular outflow tract reconstruction with an allograft conduit in patients after tetralogy of Fallot correction: long- term follow-up. Ann Thorac Surg 2001; 92: 161–166.CrossRefGoogle Scholar
31. Oosterhof, T, Meijboom, FJ, Vliegen, HW, et al. Long-term follow-up of homograft function after pulmonary valve replacement in patients with tetralogy of Fallot. Eur Heart J 2006; 27: 1478–1484.CrossRefGoogle ScholarPubMed
32. Shin, HJ, Kim, YH, Ko, JK, Park, IS, Seo, DM. Outcomes of mechanical valves in the pulmonic position in patients with congenital heart disease over a 20-year period. Ann Thorac Surg in press; doi:10.1016/j.athoracsur.2012.07.008.CrossRefGoogle Scholar
33. Waterbolk, TW, Hoendermis, ES, den Hamer, IJ, Ebels, T. Pulmonary valve replacement with a mechanical prosthesis. Promising results of 28 procedures in patients with congenital heart disease. Eur J Cardiothorac Surg 2006; 30: 28–34.CrossRefGoogle ScholarPubMed
34. Stulak, JM, Dearani, JA, Burkhart, HM, et al. The increasing use of mechanical pulmonary valve replacement over a 40-year period. Ann Thorac Surg 2010; 90: 2009–2015.CrossRefGoogle Scholar
35. Quintessenza, JA, Jacobs, JP, Morell, VO, Giroud, JM, Boucek, RJ. Initial experience with a bicuspid polytetrafluoroethylene pulmonary valve in 41 children and adults: a new option for right ventricular outflow tract reconstruction. Ann Thorac Surg 2005; 79: 924–931.CrossRefGoogle ScholarPubMed
36. Quintessenza, JA. Polytetrafluoroethylene bicuspid pulmonary valve implantation. Oper Tech Thorac Cardiovasc Surg 2008; 13: 244–249.CrossRefGoogle Scholar
37. Brown, JW, Ruzmetov, M, Vijay, P, Rodefeld, MD, Turrentine, MW. Right ventricular outflow tract reconstruction with a polytetrafluoroethylene monocusp valve: a twelve-year experience. J Thorac Cardiovasc Surg 2007; 133: 1336–1343.CrossRefGoogle Scholar
38. Quintessenza, JA, Jacobs, JP, Chai, PJ, Morell, VO, Lindberg, H. Polytetrafluoroethylene bicuspid pulmonary valve implantation: experience with 126 patients. World J Pediatr Congenit Heart Surg 2010; 1: 20–27.CrossRefGoogle ScholarPubMed
39. Lee, C, Lee, CH, Kwak, JG, et al. Bicuspid pulmonary valve implantation using polytetrafluoroethylene membrane: early results and assessment of the valve function by magnetic resonance imaging. Eur J Cardiothorac Surg in press; doi:10.1093/ejcts/ezs381.CrossRefGoogle Scholar
40. Warnes, CA, Williams, RG, Bashore, TM, et al. ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines for the management of adults with congenital heart disease). Circulation 2008; 118: 2395–2451.CrossRefGoogle Scholar
41. Lee, C, Kim, YM, Lee, CH, et al. Outcomes of pulmonary valve replacement in 170 patients with chronic pulmonary regurgitation after relief of right ventricular outflow tract obstruction: implications for optimal timing of pulmonary valve replacement. J Am Coll Cardiol 2012; 60: 1005–1014.CrossRefGoogle ScholarPubMed
42. 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: 9–32.CrossRefGoogle ScholarPubMed
43. Henkens, IR, van Straten, A, Schalij, MJ, et al. Predicting outcome of pulmonary valve replacement in adult tetralogy of Fallot patients. Ann Thorac Surg 2007; 83: 907–911.CrossRefGoogle ScholarPubMed

Lee Supplementary Material

Movie

Download Lee Supplementary Material(Video)
Video 48 MB