Transannular outflow tract patch

The test and the control patches were harvested 324 months later. The present study aims to compare the outcomes of tof repair using polytetrafluoroethylene ptfe patch versus autologous glutaraldehyde fixed pericardial patch for rvot reconstruction. Transannular patch repair of doubleoutlet right ventricle. Reconstruction of the right ventricular outflow tract with a transannular patch for ventricular tachycardia refractory to radiofrequency catheter ablation in a patient who underwent tetralogy of fallot surgery in childhood. Timedependent linear stepwise multivariate discriminant analysis showed that extent of right ventricular outflow tract patch transannular greater than none greater than right ventricular andor separate pulmonary arterial, longer ischemic arrest time, previous palliative shunt, and primary suture closure of the ventricular septal defect. Effect of transannular patching on outcome after repair of tetralogy of fallot james k. At the age of 29, he presented with palpitations and sustained vt. A transannular patch tap was used in the reconstruction of the right ventricular outflow tract in 191 32% of these patients and had no influence on late mortality but the eventfree survival was significantly inferior in these patients. When this was completed i then took a goretex patch and patched the pulmonary artery and right ventricular outflow tract anteriorly. Right ventricular outflow tract reconstruction with contegra monocuspid transannular patch in tetralogy of fallot article in the annals of thoracic surgery. Use of a pulmonary neovalve with a transannular patch for. Cardiac repair with transannular patch enlargement of the pulmonary outflow was planned. Surgical strategies protecting against right ventricular. Imaging studies revealed a mass obstructing the rvot.

In patients with free pulmonary regurgitation and right ventricular dilatation after transannular patch repair, we have observed that the pulmonary outflow tract can dilate and elongate craniad and rotate to the left, resulting in kinking and obstruction of the previously normal left pulmonary artery. Since rastelli first described surgical repair for pulmonary valve, surgeons performed various techniques up to anatomic situation of the rvot and pulmonary valve. Six sheep, in which a transannular dacron patch was implanted, served as control group. A monocusp may be created with autologous or bovine pericardium 2, homograft pulmonary valve cusp, or as reported in this technique section, the use of ptfe pericardial membrane 0. Valvesparing surgery for tetralogy of fallot procedure.

The goretex patch was sewed in place with a running 4 0 prolene suture. Patients were analyzed on the basis of diagnosis and the method of right ventricular outflow tract reconstruction. Treatment of fallot tetralogy with a transannular patch. To our knowledge, proper positioning of a transannular patch has not been discussed in the literature. Monocusp valve and transannular patch reconstruction of the right ventricular outflow tract. A monocusp goretex pulmonary valve was then constructed and sewn to the ventriculotomy using 60 prolene in a running fashion. To ensure that our data expressed the actual relationship between the pva diameter zscore and the pva gradient, we attempted to define a subgroup of patients within the tetralogy group for whom the echocardiographically determined peak velocity across the right ventricular outflow tract would define the pulmonary valvar stenosis as purely as. Ninetysix percent of surviving patients were in new york heart association functional class i at. Right ventricular outflow tract reconstruction with. Right ventricular outflow tract reconstruction using a.

We compared regional right ventricular rv strain in repaired tof with valvar pulmonary stenosis vps after balloon valvuloplasty to investigate the effects of tap. Case report this report describes a 29yearold male who underwent a complete tof repair at 2 years of age with a non transannular rvot patch. Reconstruction of the right ventricular outflow tract with a. Ptfe monocusp valve for rvot reconstruction ctsnet. Iorio, gianluca oricchio, roberta iacobelli, antonio amodeo, roberto m. A new technique of transannular monocusp patchrepair of the right. Initial results using a transannular patch with a modified monocusp valve to repair the outflow tract in the tetralogy of fallot were promising. The total predicted postrepair pa,, without a transannular patch is the sum of the predicted prv,lv in figs 1 and 3. Cardiovascular mr imaging after surgical correction of. Although many patients tolerate this indefinitely, 30% to 40% will require later valve placement.

Left pulmonary artery kinking caused by outflow tract dilatation after transannular patch repair of tetralogy of fallot annals of thoracic surgery mcelhinney, d. The anomalous position of the pulmonary valve poses difficulties with surgical relief of the pulmonary outflow tract obstruction in that the rca crosses the pulmonary outflow tract and may hinder transannular patch placement. Once the radical repair indicated, usually there are two ways to enlarge the stenotic, hypoplastic right ventricular outflow tract andor pulmonary valve. Right ventricular outflow tract transannular patch placement. Recent evidence indicates, however, that use of a transannular patch can cause pulmonary insufficiency, or weakness in the pulmonary valve that allows backflow of blood into the right ventricle. Need of transannular patch in tetralogy of fallot surgery.

Pdf reconstruction of the right ventricular outflow. A noncontractile transannular patch tap in the right ventricular outflow tract rvot contributes to ventricular dysfunction after tetralogy of fallot tof repair. Correction with transannular patch was performed in 80%, as reported by seddio et al. Relief of rvot obstruction can be achieved by means of pulmonary valvotomy, resection of hypertrophied muscle bundles, or placement of a transannular outflow tract patch in those patients with severe pulmonary valve hypoplasia. Iorio, gianluca oricchio, roberta iacobelli, antonio amodeo. Late pulmonary valve placement after tetralogy repair with. But the the geometric relationship between a monocusp patch. Postoperatively, the righttoleft ventricular pressure ratio was outflow tract obstruction in that the rca crosses the pulmonary outflow tract and may hinder transannular patch placement. Stenosis of the branch pulmonary arteries after tetralogy of fallot repair can result from several mechanisms. An angiogram showed sufficient space at the right side of the subpulmonary conus between the pulmonary valve and the rca fig 1. Postoperative size of the right ventricular outflow tract and optimal age in complete repair of tetralogy of fallot. Precise suturing of the vsd patch, adequate infundibular resection and lower threshold for a transannular patch placement ensures a smooth early postoperative recovery.

Right ventricular dysfunction due to right ventricular. Right ventricular outflow tract reconstruction with contegra monocuspid transannular patch in tetralogy of fallot in. Right ventricular outflow tract obstruction caused by a. Right ventricular outflow tract reconstruction using a goret.

Longterm results of right ventricular outflow tract. However, if there is also a need to widen the outflow tract of the right ventricle, a transannular patch may be required. For patients of tof with pulmonary annular hypoplasia, reconstruction of right ventricular outflow tract rvot often requires a trans annular patch tap. Right ventricular outflow tract rvot reconstruction had always become a challenge in congenital heart diseases for the surgeons. Tetralogy of fallot with subarterial ventricular septal. An interesting alternative strategy is the creation of a monocusp rv outflow tract patch. Blood pressure against the defective bovine pericardial transannular patch creates an aneurysm, which grows substantially larger until it bursts. In all these surgical approaches preventing the pulmonary. Indications for surgery include progressive right ventricular dilatation and dysfunction. Absorbable, nonwoven patches made from polyhydroxybutyrate phb were implanted as transannular patches into the right ventricular outflow tract and pulmonary artery in weanling sheep, the test group. The rvot right ventricular outflow tract is located between supraventricular crest and pulmonary valve. Right ventricular outflow tract medical billing and coding. A new technique of transannular monocusp patchrepair of. A pulmonary homograft valved conduit is the replacement of choice.

Monocusp valve and transannular patch reconstruction of the. Transannular patching is a valid alternative for tetralogy of fallot and complete atrioventricular septal defect repair gianluca brancaccio, guido michielon, sergio filippelli, gianluigi perri, duccio di carlo, fiore s. Reconstruction of the right ventricular outflow tract with a transannular patch for ventricular tachycardia refractory to radiofrequency catheter ablation in a. Right ventricular outflow tract strategies for repair of tetralogy of. Reconstruction of the right ventricular outflow tract with. Monocusp valve and transannular patch reconstruction of. Patients who had a patch, whether transannular or limited to the right ventricle, had a larger ratio than the ones who had a direct closure of a right ventriculotomy 0. Pediatric diminutive right ventricular outflow tract rvot reconstruction with homografts or porcine xenografts remains challenging because of limited availability, early degeneration, tissue ingrowth, and child growth. Ventricular septal defect was closed with a hemashield patch boston scientific, natick, massachusetts. Outflow tract repair was carried out in four different ways.

Effect of transannular patching on outcome after repair of. A transannular patch of autologous pericardium was then used to reconstruct anterior aspect of the right ventricular outflow tract using 50 prolene in a running fashion. Transannular patch augmentation of the right ventricular outflow tract rvot is required in a significant proportion of these patients. 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. The objective of this study was to assess whether contegra valved bovine conduit, implanted as monocuspid transannular patch, might be an interesting. Right ventricular outflow tract transannular patch placement without. Aufiero, kyung sun, robert binford, glenn carlos, john w. Right ventricular outflow tract reconstruction with contegra. In children with pulmonary atresia not amenable to initial complete correction, antegrade pulmonary blood flow can be established with surgical. A new technique of transannular monocusp patchrepair of the right ventricular outflow tract in repair of tetralogy of fallot.

To introduce a new technique to create a pulmonary valve biorifice for the reconstruction of the right ventricular outflow tract in tetralogy of fallot tof, and to summarize the initial clinical experiment. Right ventricular outflow tract reconstruction with contegra monocuspid transannular patch in tetralogy of fallot. An in vitro study of the influence of monocusp patch size on. The impact of the right ventricular outflow tract patch on.

A new technique of transannular monocusp patchrepair of the right ventricular outflow tract in repair of tetralogy of. For relief of right ventricular outflow tract obstruction in the operative treatment of tetralogy of fallot and other complex congenital heart disease, it is often necessary to perform transannular monocusp patch to prevent right ventricular pressure overload and reduce pulmonary regurgitation. Eleven infant goats group a and 12 infant sheep group b underwent rvot reconstruction under cardiopulmonary bypass. An 11year experience with rvot transannular patch tap augmentation without the use of cardiopulmonary bypass offpump is reported. Right ventricular outflow tract prosthesis in total correction of tetralogy of fallot. Note that there is a mild pulmonary regurgitation arrow with a widely open rvot, pa annulus and a functioning monocusp.

Tetralogy of fallot animation part 4 anatomical justice. Operative correction of the pulmonary outflow tract obstruction with or without tof, frequently requires transannular enlargement because of the infundibular andor annularvalvular obstruction. The valve was secured anteriorly to the goretex patch. Following adequate rewarming, the patient is weaned from cardiopulmonary bypass. We examined the feasibility of using a polytetrafluoroethylene membrane goretex valve and transannular patch tap for right ventricular outflow tract rvot reconstruction in growing animal models. Right ventricular outflow tract reconstruction with contegra monocuspid transannular patch in tetralogy of fallot author links open overlay panel bruno chiappini md, phd a catherine barrea md b jean rubay md, phd a. At surgery, a longitudinal incision was made in the right. Total repair of tetralogy of fallot radiology reference. Right ventricular outflow tract reconstruction with contegra monocuspid transannular patch in tetralogy of fallot article in the annals of thoracic surgery 831.

This conventional technique is usually a reason for late pulmonary insufficiency. The narrowing in the pulmonary valve is also repaired with the transannular patch to improve blood flow to the lungs. In addition, we discuss the appearance of anatomic and physiologic complications late after tof repair, cardiovascular mr sequences used in the functional evaluation of the severity of these. The new technique of reconstructing the right ventricular outflow tract with pulmonary valve biorifice was used in 53 cases of tof the observation group. Transannular patching is a valid alternative for tetralogy of fallot and. Transannular patching is a valid alternative for tetralogy of. Relationship between type of outflow tract repair and.

Occasionally, placement of a tube graft conduit between the right. Enlargement of the right ventricular outflow tract and the. Right ventricular outflow tract strategies for repair of. A 43yearold man with a surgical history of atrial septal defect asd patch closure and transannular right ventricular outflow tract rvot reconstruction using a dacron patch 30 years ago visited our hospital due to dyspnea on exertion nyha class ii, which started 4 months prior to presentation. With contegra monocuspid transannular patch in tetralogy of fallot. An in vitro study of the influence of monocusp patch size. Right ventricular outflow tract transannular patch placement without cardiopulmonary bypass. Right ventricular outflow tract transannular patch.

Jan 31, 2017 a noncontractile transannular patch tap in the right ventricular outflow tract rvot contributes to ventricular dysfunction after tetralogy of fallot tof repair. When a transannular patch is used, the distal extent of the incision into the pulmonary trunk is of major consideration to. Case report this report describes a 29yearold male who underwent a complete tof repair at 2 years of age with a nontransannular rvot patch. If the predicted prvjlv is higher than the acceptable value selected by the surgeon, a transannular patch is constructed. The median age, weight and pv zvalue of group b patients were significantly lower.

If a patch is inserted, it may be used to widen the pulmonary artery from the valve upward. Right ventricular outflow tract medical billing and. The objective of this study was to assess whether contegra valved bovine conduit, implanted as monocuspid transannular patch, might be an interesting alternative to overcome. Pdf reconstruction of the right ventricular outflow tract. Transannular patching is a valid alternative for tetralogy. Right ventricular outflow tract obstruction was relieved by transannular patch in 14 cases 42%, infundibular patch with preservation of the pulmonary valve in 7. This patch covers part of the wall of the right ventricle as well as widening the pulmonary artery and pulmonary valve. Pulmonary stenosis congenital heart disease cove point. Rvot right ventricular outflow tract atlas of human.