Treatment Progress of Chronic Postoperative Pulmonary Regurgitation after Surgical Repair of Tetralogy of Fallot_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Yiming , LU Lianghua , MO Xuming.

Department of Thoracic and Cardiovascular Surgery, Nanjing Children’s Hospital, Nanjing Medical University, Nanjing 210008, P. R. China;

Corresponding author：

Keywords：

Tetralogy of Fallot; Pulmonary regurgitation; Pulmonary valve replacement

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Abstract： With the evolvement of surgical, anesthetic, perfusion, and perioperative management techniques, the mortality of routine corrective operation of tetralogy of Fallot（TOF） has been less than 2%-3%, while more and more attention has been paid to patient long-term prognosis. Chronic postoperative pulmonary regurgitation （PR） is one of the important prognostic factors which are puzzling cardiac surgeons. Subsequent right ventricle dilation, right ventricular dysfunction and fatal arrhythmias as chronic PR complications have important impact on the postoperative quality of life and long-
term survival. Current treatment choice for PR includes pulmonary valve replacement（PVR）, intervention, and hybrid procedures. PVR is the main surgical method for chronic PR which can significantly improve patient cardiac function and clinical symptoms，and prolong long-term survival. Intervention does not require thoracotomy once again, and can thus reduce surgical trauma and risks. Intervention is also helpful to improve right ventricular pressure conditions and PR degree. This article focuses on the pathophysiological changes of chronic PR after surgical repair of TOF, surgical indications for PVR, clinical treatment progress and early prevention of PR.

Citation： LIU Yiming,LU Lianghua,MO Xuming.. Treatment Progress of Chronic Postoperative Pulmonary Regurgitation after Surgical Repair of Tetralogy of Fallot. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(3): 304-308. doi: Copy

1.	Armonk, NY： Futura, 1993. 33-62.
2.	Perry LW, Neill CA, Ferencz C, et al. Congenital heart disease： perspective in pediatric cardiology. Epidemiology of congenital heart disease, the baltimore-washington infant study 1981～1989.
3.	Bacha EA, Scheule AM, Zurakowski D， et al. Long-term results after early primary repair of tetralogy of Fallot. J Thorac Cardiovasc Surg, 2001, 122（1）：154-161.
4.	Parry AJ, McElhinney DB, Kung GC, et al. Elective primary repair of acyanotic tetralogy of Fallot in early infancy： overall outcome and impact on the pulmonary valve. J Am Coll Cardiol, 2000, 36（7）：2279-2283.
5.	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（9）：593-599.
6.	Nollert G, Fischlein T, Bouterwek S, et al. Long-term survival in patients with repair of tetralogy of Fallot： 36-year follow-up of 490 survivors of the first year after surgical repair. J Am Coll Cardiol, 1997, 30（5）：1374-1383.
7.	Wessel HU, Paul MH. Exercise studies in tetralogy of Fallot： a review. Pediatr Cardiol, 1999, 20（1）：39-48.
8.	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（9234）：975-981.
9.	Geva T, Sandweiss BM, Gauvreau K, et al. 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（6）：1068-1074.
10.	Hickey EJ, Veldtman G, Bradley TJ, et al. Late risk of outcomes for adults with repaired tetralogy of Fallot from an inception cohort spanning four decades. Eur J Cardiothorac Surg, 2009, 35（1）：156-164.
11.	Frigiola A, Redington AN, Cullen S, et al. Pulmonary regurgitation is an important determinant of right ventricular contractile dysfunction in patients with surgically repaired tetralogy of Fallot. Circulation, 2004, 110（11 Suppl 1）：II153- II 157.
12.	Harrison DA, Harris L, Siu SC, et al. Sustained ventricular tachycardia in adult patients late after repair of tetralogy of Fallot. J Am Coll Cardiol, 1997, 30（5）：1368-1373.
13.	Geva T. Indications and timing of pulmonary valve replacement after tetralogy of Fallot repair. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2006, 11-22.
14.	Oosterhof T, Hazekamp MG, Mulder BJ. Opportunities in pulmonary valve replacement. Expert Rev Cardiovasc Ther, 2009, 7（9）：1117-1122.
15.	Therrien J, Siu SC, McLaughlin PR, et al. Pulmonary valve replacement in adults late after repair of tetralogy of fallot： are we operating too late? J Am Coll Cardiol, 2000, 36（5）：1670-1675.
16.	Borowski A, Ghodsizad A, Litmathe J, et al. Severe pulmonary regurgitation late after total repair of tetralogy of Fallot： surgical considerations. Pediatr Cardiol, 2004, 25（5）：466-471.
17.	d′Udekem Y, Ovaert C, Grandjean F, et al. Tetralogy of Fallot： transannular and right ventricular patching equally affect late functional status. Circulation, 2000, 102（19 Suppl 3）：Ⅲ116-Ⅲ122.
18.	de Ruijter FT, Weenink I, Hitchcock FJ, et al. Right ventricular dysfunction and pulmonary valve replacement after correction of tetralogy of Fallot. Ann Thorac Surg, 2002, 73（6）：1794-1800.
19.	Gatzoulis MA, Till JA, Somerville J, et al. Mechanoelectrical interaction in tetralogy of Fallot. QRS prolongation relates to right ventricular size and predicts malignant ventricular arrhythmias and sudden death. Circulation, 1995, 92（2）：231-237.
20.	Adamson L, Vohra HA, Haw MP. Does pulmonary valve replacement post repair of tetralogy of Fallot improve right ventricular function? Interact Cardiovasc Thorac Surg, 2009, 9（3）：520-527.
21.	Frigiola A, Tsang V, Nordmeyer J, et al. Current approaches to pulmonary regurgitation. Eur J Cardiothorac Surg, 2008, 34（3）：576-580.
22.	van Straten A, Vliegen HW, Hazekamp MG, et al. Right ventricular function after pulmonary valve replacement in patients with tetralogy of Fallot. Radiology, 2004, 233（3）：824-829.
23.	Kane C, Kogon B, Pernetz M, et al. Left ventricular function improves after pulmonary valve replacement in patients with previous right ventricular outflow tract reconstruction and biventricular dysfunction. Tex Heart Inst J, 2011, 38（3）：234-237.
24.	Lim C, Lee JY, Kim WH, et al. Early replacement of pulmonaryvalve after repair of tetralogy： is it really beneficial? Eur J Cardiothorac Surg, 2004, 25（5）：728-734.
25.	Rosti L, Murzi B, Colli AM, et al. Pulmonary valve replacement： a role for mechanical prostheses? Ann Thorac Surg, 1998, 65（3）：889-890.
26.	Miyamura H, Kanazawa H, Hayashi J, et al. Thrombosed St. Jude Medical valve prosthesis in the right side of the heart in patients with tetralogy of Fallot. J Thorac Cardiovasc Surg, 1987, 94（1）：148-150.
27.	Haas F, Schreiber C, Horer J, et al. Is there a role for mechanical valved conduits in the pulmonary position? Ann Thorac Surg, 2005, 79（5）：1662-1668.
28.	Dave HH, Kadner A, Berger F, et al. Early results of the bovine jugular vein graft used for reconstruction of the right ventricular outflow tract. Ann Thorac Surg, 2005, 79（2）：618-624.
29.	Boudjemline Y, Bonnet D, Agnoletti G, et al. Aneurysm of the right ventricular outflow following bovine valved venous conduit insertion. Eur J Cardiothorac Surg, 2003, 23（1）：122-124.
30.	Bonhoeffer P, Boudjemline Y, Saliba Z, et al. Percutaneous replacement of pulmonary valve in a right-ventricle to pulmonary-artery prosthetic conduit with valve dysfunction. Lancet, 2000, 356（9239）：1403-1405.
31.	Khambadkone S, Coats L, Taylor A, et al. Percutaneous pulmonary valve implantation in humans： results in 59 consecutive patients.Circulation, 2005, 112（8）：1189-1197.
32.	Lurz P, Coats L, Khambadkone S, et al. Percutaneous pulmonary valve implantation： impact of evolving technology and learning curve on clinical outcome. Circulation, 2008, 117（15）：1964-1972.
33.	Eicken A, Ewert P, Hager A, et al. Percutaneous pulmonary valve implantation： two-centre experience with more than 100 patients. Eur Heart J, 2011, 32（10）：1260-1265.
34.	Schreiber C, Horer J, Vogt M, et al. A new treatment option for pulmonary valvar insufficiency：first experiences with implantation of a self-expanding stented valve without use of cardiopulmonary bypass. Eur J Cardiothorac Surg, 2007, 31（1）：26-30.
35.	Schreiber C, Bauernschmitt R, Augustin N, et al. Implantation of a prosthesis mounted inside a self-expandable stent in the pulmonary valvar area without use of cardiopulmonary bypass. Ann Thorac Surg, 2006, 81（1）：e1-3.
36.	Bouzas B, Kilner PJ, Gatzoulis MA. Pulmonary regurgitation：not a benign lesion. Eur Heart J, 2005, 26（5）：433-439.
37.	van den Berg J, Hop WC, Strengers JL, et al. Clinical condition at mid-to-late follow-up after transatrial-transpulmonary repair of tetralogy of Fallot. J Thorac Cardiovasc Surg , 2007, 133（2）：470-477.
38.	Yamagishi M, Kurosawa H. Outflow reconstruction of tetralogy of Fallot using a Gore-Tex valve. Ann Thorac Surg, 1993, 56（6）：1414-1417.
39.	Hazekamp MG, Kurvers MM, Schoof PH, et al. Pulmonary valve insertion late after repair of Fallot’s tetralogy. Eur J Cardiothorac Surg, 2001, 19（5）：667-670.
40.	Pande S, Agarwal SK, Majumdar G, et al. Pericardial monocusp for pulmonary valve reconstruction： a new technique. Asian Cardiovasc Thorac Ann, 2010, 18（3）：279-284.
41.	Corno AF, Qanadli SD, Sekarski N, et al. Bovine valved xenograft in pulmonary position： medium-term follow-up with excellent hemodynamics and freedom from calcification. Ann Thorac Surg, 2004, 78 （4）：1382-1388.
42.	Chiappini B, Barrea C, Rubay J. Right ventricular outflow tract reconstruction with contegra monocuspid transannular patch in tetralogy of Fallot. Ann Thorac Surg, 2007, 83（1）：185-187.
43.	Cebotari S, Lichtenberg A, Tudorache I, et al. Clinical application of tissue engineered human heart valves using autologous progenitor cells. Circulation, 2006, 114（1 Suppl）：I132-I137.

1. Armonk, NY： Futura, 1993. 33-62.
2. 　Perry LW, Neill CA, Ferencz C, et al. Congenital heart disease： perspective in pediatric cardiology. Epidemiology of congenital heart disease, the baltimore-washington infant study 1981～1989.
3. 　Bacha EA, Scheule AM, Zurakowski D， et al. Long-term results after early primary repair of tetralogy of Fallot. J Thorac Cardiovasc Surg, 2001, 122（1）：154-161.
4. 　Parry AJ, McElhinney DB, Kung GC, et al. Elective primary repair of acyanotic tetralogy of Fallot in early infancy： overall outcome and impact on the pulmonary valve. J Am Coll Cardiol, 2000, 36（7）：2279-2283.
5. 　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（9）：593-599.
6. 　Nollert G, Fischlein T, Bouterwek S, et al. Long-term survival in patients with repair of tetralogy of Fallot： 36-year follow-up of 490 survivors of the first year after surgical repair. J Am Coll Cardiol, 1997, 30（5）：1374-1383.
7. 　Wessel HU, Paul MH. Exercise studies in tetralogy of Fallot： a review. Pediatr Cardiol, 1999, 20（1）：39-48.
8. 　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（9234）：975-981.
9. 　Geva T, Sandweiss BM, Gauvreau K, et al. 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（6）：1068-1074.
10. 　Hickey EJ, Veldtman G, Bradley TJ, et al. Late risk of outcomes for adults with repaired tetralogy of Fallot from an inception cohort spanning four decades. Eur J Cardiothorac Surg, 2009, 35（1）：156-164.
11. 　Frigiola A, Redington AN, Cullen S, et al. Pulmonary regurgitation is an important determinant of right ventricular contractile dysfunction in patients with surgically repaired tetralogy of Fallot. Circulation, 2004, 110（11 Suppl 1）：II153- II 157.
12. 　Harrison DA, Harris L, Siu SC, et al. Sustained ventricular tachycardia in adult patients late after repair of tetralogy of Fallot. J Am Coll Cardiol, 1997, 30（5）：1368-1373.
13. 　Geva T. Indications and timing of pulmonary valve replacement after tetralogy of Fallot repair. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2006, 11-22.
14. 　Oosterhof T, Hazekamp MG, Mulder BJ. Opportunities in pulmonary valve replacement. Expert Rev Cardiovasc Ther, 2009, 7（9）：1117-1122.
15. 　Therrien J, Siu SC, McLaughlin PR, et al. Pulmonary valve replacement in adults late after repair of tetralogy of fallot： are we operating too late? J Am Coll Cardiol, 2000, 36（5）：1670-1675.
16. 　Borowski A, Ghodsizad A, Litmathe J, et al. Severe pulmonary regurgitation late after total repair of tetralogy of Fallot： surgical considerations. Pediatr Cardiol, 2004, 25（5）：466-471.
17. 　d′Udekem Y, Ovaert C, Grandjean F, et al. Tetralogy of Fallot： transannular and right ventricular patching equally affect late functional status. Circulation, 2000, 102（19 Suppl 3）：Ⅲ116-Ⅲ122.
18. 　de Ruijter FT, Weenink I, Hitchcock FJ, et al. Right ventricular dysfunction and pulmonary valve replacement after correction of tetralogy of Fallot. Ann Thorac Surg, 2002, 73（6）：1794-1800.
19. 　Gatzoulis MA, Till JA, Somerville J, et al. Mechanoelectrical interaction in tetralogy of Fallot. QRS prolongation relates to right ventricular size and predicts malignant ventricular arrhythmias and sudden death. Circulation, 1995, 92（2）：231-237.
20. 　Adamson L, Vohra HA, Haw MP. Does pulmonary valve replacement post repair of tetralogy of Fallot improve right ventricular function? Interact Cardiovasc Thorac Surg, 2009, 9（3）：520-527.
21. 　Frigiola A, Tsang V, Nordmeyer J, et al. Current approaches to pulmonary regurgitation. Eur J Cardiothorac Surg, 2008, 34（3）：576-580.
22. 　van Straten A, Vliegen HW, Hazekamp MG, et al. Right ventricular function after pulmonary valve replacement in patients with tetralogy of Fallot. Radiology, 2004, 233（3）：824-829.
23. 　Kane C, Kogon B, Pernetz M, et al. Left ventricular function improves after pulmonary valve replacement in patients with previous right ventricular outflow tract reconstruction and biventricular dysfunction. Tex Heart Inst J, 2011, 38（3）：234-237.
24. 　Lim C, Lee JY, Kim WH, et al. Early replacement of pulmonaryvalve after repair of tetralogy： is it really beneficial? Eur J Cardiothorac Surg, 2004, 25（5）：728-734.
25. 　Rosti L, Murzi B, Colli AM, et al. Pulmonary valve replacement： a role for mechanical prostheses? Ann Thorac Surg, 1998, 65（3）：889-890.
26. 　Miyamura H, Kanazawa H, Hayashi J, et al. Thrombosed St. Jude Medical valve prosthesis in the right side of the heart in patients with tetralogy of Fallot. J Thorac Cardiovasc Surg, 1987, 94（1）：148-150.
27. 　Haas F, Schreiber C, Horer J, et al. Is there a role for mechanical valved conduits in the pulmonary position? Ann Thorac Surg, 2005, 79（5）：1662-1668.
28. 　Dave HH, Kadner A, Berger F, et al. Early results of the bovine jugular vein graft used for reconstruction of the right ventricular outflow tract. Ann Thorac Surg, 2005, 79（2）：618-624.
29. 　Boudjemline Y, Bonnet D, Agnoletti G, et al. Aneurysm of the right ventricular outflow following bovine valved venous conduit insertion. Eur J Cardiothorac Surg, 2003, 23（1）：122-124.
30. 　Bonhoeffer P, Boudjemline Y, Saliba Z, et al. Percutaneous replacement of pulmonary valve in a right-ventricle to pulmonary-artery prosthetic conduit with valve dysfunction. Lancet, 2000, 356（9239）：1403-1405.
31. 　Khambadkone S, Coats L, Taylor A, et al. Percutaneous pulmonary valve implantation in humans： results in 59 consecutive patients.Circulation, 2005, 112（8）：1189-1197.
32. 　Lurz P, Coats L, Khambadkone S, et al. Percutaneous pulmonary valve implantation： impact of evolving technology and learning curve on clinical outcome. Circulation, 2008, 117（15）：1964-1972.
33. 　Eicken A, Ewert P, Hager A, et al. Percutaneous pulmonary valve implantation： two-centre experience with more than 100 patients. Eur Heart J, 2011, 32（10）：1260-1265.
34. 　Schreiber C, Horer J, Vogt M, et al. A new treatment option for pulmonary valvar insufficiency：first experiences with implantation of a self-expanding stented valve without use of cardiopulmonary bypass. Eur J Cardiothorac Surg, 2007, 31（1）：26-30.
35. 　Schreiber C, Bauernschmitt R, Augustin N, et al. Implantation of a prosthesis mounted inside a self-expandable stent in the pulmonary valvar area without use of cardiopulmonary bypass. Ann Thorac Surg, 2006, 81（1）：e1-3.
36. 　Bouzas B, Kilner PJ, Gatzoulis MA. Pulmonary regurgitation：not a benign lesion. Eur Heart J, 2005, 26（5）：433-439.
37. 　van den Berg J, Hop WC, Strengers JL, et al. Clinical condition at mid-to-late follow-up after transatrial-transpulmonary repair of tetralogy of Fallot. J Thorac Cardiovasc Surg , 2007, 133（2）：470-477.
38. 　Yamagishi M, Kurosawa H. Outflow reconstruction of tetralogy of Fallot using a Gore-Tex valve. Ann Thorac Surg, 1993, 56（6）：1414-1417.
39. 　Hazekamp MG, Kurvers MM, Schoof PH, et al. Pulmonary valve insertion late after repair of Fallot’s tetralogy. Eur J Cardiothorac Surg, 2001, 19（5）：667-670.
40. 　Pande S, Agarwal SK, Majumdar G, et al. Pericardial monocusp for pulmonary valve reconstruction： a new technique. Asian Cardiovasc Thorac Ann, 2010, 18（3）：279-284.
41. 　Corno AF, Qanadli SD, Sekarski N, et al. Bovine valved xenograft in pulmonary position： medium-term follow-up with excellent hemodynamics and freedom from calcification. Ann Thorac Surg, 2004, 78 （4）：1382-1388.
42. 　Chiappini B, Barrea C, Rubay J. Right ventricular outflow tract reconstruction with contegra monocuspid transannular patch in tetralogy of Fallot. Ann Thorac Surg, 2007, 83（1）：185-187.
43. 　Cebotari S, Lichtenberg A, Tudorache I, et al. Clinical application of tissue engineered human heart valves using autologous progenitor cells. Circulation, 2006, 114（1 Suppl）：I132-I137.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Treatment Progress of Chronic Postoperative Pulmonary Regurgitation after Surgical Repair of Tetralogy of Fallot

Abstract Full text Figures/Tables Video References Cited by

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