Tetralogy of Fallot repair: optimal z-score use for transannular patch insertion
Open Access
- 4 July 2012
- journal article
- research article
- Published by Oxford University Press (OUP) in European Journal of Cardio-Thoracic Surgery
- Vol. 43 (3), 483-486
- https://doi.org/10.1093/ejcts/ezs372
Abstract
Transannular patching is used to relieve significant pulmonary annular stenosis during tetralogy of Fallot repair. Although recent literature has focused on the deleterious effects of pulmonary regurgitation, inadequate relief of stenosis may increase postoperative mortality and the re-intervention rate. Patching criteria based on pulmonary annular z-scores are ambiguous because of the use of varied z-score data sets. This study aimed to generate data that could be used to optimize z-score use for patch insertion. A retrospective review was made of medical records of patients who had a valve-sparing repair of tetralogy of Fallot between 1 January 2000 and 31 December 2010. In a selected group in which the residual gradient was confined to the pulmonary valve, the post-repair peak pressure gradient was determined by trans-thoracic echocardiography and was correlated with the intra-operative pulmonary valve annulus (PVA) diameter z-score. Regression analysis was used to examine this relationship. Data from 46 patients with valve-sparing repair were reviewed; the median age and median weight were 6.5 months and 6.6 kg, respectively; the 30-day mortality was 2.2%. Analysis of these data implies that 25% of the time, all patients with a PVA z-score of −1.3 would have a PVA gradient ≥30 mmHg. Criteria that recommend a transannular patch insertion only when the PVA diameter z-score is significantly smaller than −1.3 (e.g. −3) may result in a significant number of patients with an unacceptable post-repair PVA gradient.Keywords
This publication has 16 references indexed in Scilit:
- Optimal Normative Pediatric Cardiac Structure Dimensions for Clinical UseWorld Journal for Pediatric and Congenital Heart Surgery, 2010
- Early Primary Repair of Tetralogy of FallotSeminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual, 2009
- Regression Equations for Calculation of Z Scores of Cardiac Structures in a Large Cohort of Healthy Infants, Children, and Adolescents: An Echocardiographic StudyJournal of the American Society of Echocardiography, 2008
- Tetralogy of Fallot with and without Pulmonary AtresiaPublished by Elsevier BV ,2006
- Tetralogy of Fallot: Results of a Pulmonary Valve-Sparing StrategyThe Annals of Thoracic Surgery, 2005
- Complete Repair of Tetralogy of Fallot in the NeonateAnnals of Surgery, 2000
- Relationship of the dimension of cardiac structures to body size: an echocardiographic study in normal infants and childrenCardiology in the Young, 1999
- Tetralogy of fallot: Favorable outcome of nonneonatal transatrial, transpulmonary repairThe Annals of Thoracic Surgery, 1992
- Morphologic and surgical determinants of outcome events after repair of tetralogy of Fallot and pulmonary stenosisThe Journal of Thoracic and Cardiovascular Surgery, 1992
- Intracardiac Repair of Tetralogy of Fallot in Patients Under 5 Years of AgeThe Annals of Thoracic Surgery, 1974