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The progression of an acceptable pulmonary stenosis immediately after total correction of tetralogy of Fallot

Published online by Cambridge University Press:  04 May 2020

Yi-Seul Kim ,
Jinyoung Song Open the ORCID record for Jinyoung Song [Opens in a new window] ,
June Huh ,
I-Seok Kang ,
Ji-Hyuk Yang  and
Tae-Gook Jun
Yi-Seul Kim
Affiliation:
Department of Pediatrics, Chonnam National University Hospital, Kwangju, Chonnam, Korea
Jinyoung Song*
Affiliation:
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
June Huh
Affiliation:
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
I-Seok Kang
Affiliation:
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Ji-Hyuk Yang
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Tae-Gook Jun
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
*
Author for correspondence: Jinyoung Song, MD, PhD, Department of Pediatrics, Samsung Medical Center, Heart Vascular Stroke Institute, Grown-up Congenital Heart Clinic, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul06351, Korea. Tel.: +82-2-3410-3539; Fax: +82-2-3410-0043. E-mail: amyjys@naver.com
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Abstract

Background:

A certain degree of pulmonary stenosis after total correction of tetralogy of Fallot has been considered acceptable. But the long-term outcomes are not well understood. We observed the natural course of immediate pulmonary stenosis and investigated related factors for progression.

Methods:

Fifty-two patients with acceptable pulmonary stenosis immediately after operation were enrolled. Acceptable pulmonary stenosis was defined as peak pressure gradient between 15 and 45 mmHg by Doppler echocardiography. Latent class linear mixed model was used to differentiate patients with progressed pulmonary stenosis, and the factors related to progression were analysed.

Results:

Pulmonary stenosis progressed in 14 patients (27%). Between the progression group and no progression group, there were no significant differences in operative age, sex, and the use of the transannular patch technique. However, immediate gradient was higher in the progression group (32.1 mmHg versus 25.7 mmHg, p = 0.009), and the cut-off value was 26.8 mmHg (sensitivity = 65.3%, specificity = 65.8%). Main stenosis at the sub-valve was observed more frequently in the progression group (85.7% versus 52.6%, p = 0.027). Despite no difference in the preoperative pulmonary valve z value, the last follow-up pulmonary valve z value was significantly lower in the progression group (−1.15 versus 0.35, p = 0.002).

Conclusions:

Pulmonary stenosis immediately after tetralogy of Fallot total correction might progress in patients with immediate pulmonary stenosis higher than ≥26.8 mmHg and the main site was sub-valve area.

Keywords

Tetralogy of Fallotpulmonary stenosispulmonary valvesub-valvar stenosis
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 6 , June 2020 , pp. 774 - 778
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Gott, VL.C. Walton Lillehei and total correction of tetralogy of Fallot. Ann Thorac Surg 1990; 49: 328–332.10.1016/0003-4975(90)90167-5CrossRefGoogle ScholarPubMed
van der Hulst, AE, Hylkema, MG, Vliegen, HW, et al.Mild residual pulmonary stenosis in tetralogy of fallot reduces risk of pulmonary valve replacement. Ann Thorac Surg 2012; 94: 2077–2082.10.1016/j.athoracsur.2012.06.065CrossRefGoogle ScholarPubMed
Verlinden, VJA, van der Geest, JN, de Bruijn, R, Hofman, A, Koudstaal, PJ, Ikram, MA.Trajectories of decline in cognition and daily functioning in preclinical dementia. Alzheimers Dement 2016; 12: 144–153.10.1016/j.jalz.2015.08.001CrossRefGoogle ScholarPubMed
Nollert, G, Fischlein, T, Bouterwek, S, Bohmer, C, Klinner, W, Reichart, B.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: 1374–1383.10.1016/S0735-1097(97)00318-5CrossRefGoogle ScholarPubMed
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: III116–122.Google ScholarPubMed
Mizuno, A, Niwa, K, Matsuo, K, et al.Survey of reoperation indications in tetralogy of fallot in Japan. Circ J 2013; 77: 2942–2947.10.1253/circj.CJ-13-0673CrossRefGoogle ScholarPubMed
Stewart, RD, Backer, CL, Young, L, Mavroudis, C.Tetralogy of Fallot: results of a pulmonary valve-sparing strategy. Ann Thorac Surg 2005; 80: 1431–1438; discussion 1438–1439.10.1016/j.athoracsur.2005.04.016CrossRefGoogle ScholarPubMed
Hirsch, JC, Mosca, RS, Bove, EL.Complete repair of tetralogy of Fallot in the neonate: results in the modern era. Ann Surg 2000; 232: 508–514.10.1097/00000658-200010000-00006CrossRefGoogle ScholarPubMed
Hoashi, T, Kagisaki, K, Meng, Y, et al.Long-term outcomes after definitive repair for tetralogy of Fallot with preservation of the pulmonary valve annulus. J Thorac Cardiovasc Surg 2014; 148: 802–808; discussion 808–809.10.1016/j.jtcvs.2014.06.008CrossRefGoogle ScholarPubMed
Boni, L, Garcia, E, Galletti, L, et al.Current strategies in tetralogy of Fallot repair: pulmonary valve sparing and evolution of right ventricle/left ventricle pressures ratio. Eur J Cardiothorac Surg 2009; 35: 885–889; discussion 889–890.CrossRefGoogle ScholarPubMed
Vogel, HH, Lueker, RD.Does mild pulmonary stenosis progress during childhood: a study of its natural course. Clin Cardiol 2004; 27: A22.CrossRefGoogle ScholarPubMed
Atik, E.Mild pulmonary valve stenosis: the possible spontaneous cure in the natural history of the defect. Arq Bras Cardiol 2006; 86: 378–381.Google ScholarPubMed