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Late replacement of the pulmonary valve: when and what type of valve?

Published online by Cambridge University Press:  08 September 2005

James A. Quintessenza
Affiliation:
Congenital Heart Institute of Florida, All Children's Hospital and Children's Hospital of Tampa, University of South Florida, Saint Petersburg and Tampa, Florida, United States of America
Jeffrey P. Jacobs
Affiliation:
Congenital Heart Institute of Florida, All Children's Hospital and Children's Hospital of Tampa, University of South Florida, Saint Petersburg and Tampa, Florida, United States of America
Paul J. Chai
Affiliation:
Congenital Heart Institute of Florida, All Children's Hospital and Children's Hospital of Tampa, University of South Florida, Saint Petersburg and Tampa, Florida, United States of America
Victor O. Morell
Affiliation:
The Children's Hospital of Pittsburgh, University of Pittsburgh, United States of America
Jorge M. Giroud
Affiliation:
Congenital Heart Institute of Florida, All Children's Hospital and Children's Hospital of Tampa, University of South Florida, Saint Petersburg and Tampa, Florida, United States of America
Robert J. Boucek
Affiliation:
Congenital Heart Institute of Florida, All Children's Hospital and Children's Hospital of Tampa, University of South Florida, Saint Petersburg and Tampa, Florida, United States of America

Extract

After repair of tetralogy of Fallot, many patients present in need of reoperative surgical reconstruction of the right ventricular outflow tract. The predominant physiologic lesion is pulmonary insufficiency, but there may also be varying degrees of obstruction of the right ventricular outflow tract. In the past, it has been felt that patients tolerate pulmonary insufficiency reasonably well. In some patients, however, the long-term effects of pulmonary insufficiency and subsequent right ventricular dilation and dysfunction are associated with poor exercise tolerance and increased incidence of arrhythmias and sudden death.1,2 Numerous studies support replacement of the pulmonary valve as treatment for pulmonary insufficiency in order to improve performance, optimize hemodynamics, and better control arrhythmias.3–10 The indications for reconstruction of the right ventricular outflow tract in this setting, nonetheless, as well as the operative strategy, continue to evolve. There are multiple surgical options for replacement of the pulmonary valve for these patients, including aortic and pulmonary homografts, stented and stentless porcine valves, porcine valved conduits, bovine jugular venous conduits, and even mechanical valves and mechanical valved conduits.11–32 It was a less than ideal experience with these currently available options that stimulated our interest into employing alternative materials and techniques. Favorable experimental and clinical experience with valves made of a polytetrafluoroethylene monoleaflet33–36 encouraged us to consider a new method of reconstruction with this material, using a bifoliate polytetrafluoroethylene valve. In this work, we review our indications for replacement of the pulmonary valve after repair of tetralogy of Fallot, the surgical options available, and our experience reconstructing the right ventricular outflow tract with a new surgically created bifoliate polytetrafluoroethylene valve.

Type
PART 2: TETRALOGY OF FALLOT
Copyright
© 2005 Cambridge University Press

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