2Department of Pediatric Cardiology, Ankara University Faculty of Medicine, Ankara, Türkiye DOI : 10.5606/e-cvpn.2024.262 Objectives: This study aimed to compare the impacts of right ventricular outflow tract reconstruction modalities on ventricular function in patients with tetralogy of Fallot.
Patients and methods: The files and echocardiographic examinations of 70 patients (34 males, 36 females; mean age: 5.8±8.4 years; range, 0.6 month to 31 years) who underwent total reconstruction for tetralogy of Fallot between January 2010 and December 2014 were retrospectively analyzed.
Results: Transannular patch was performed in 53 (75.7%) patients (Group A), valve-sparing surgery in four (5.7%) patients (Group B), pulmonary valve replacement with xenograft in five (7.1%) patients (Group C), and pulmonary valve replacement with homograft in eight (11.4%) patients (Group D). Twenty-eight (53%) patients in Group A needed adrenaline, while adrenaline was not needed in other groups (p=0.017). Patients in Groups C and D needed less inotropes. Pulmonary failure was observed in 52 (98.11%) patients in Group A after 28.53±16.77 months of follow-up with transthoracic echocardiography (p<0.001). While heart failure was observed in one (25%) patient in Group B, it was not encountered in Groups C and D (p<0.001). A decrease in ejection fraction and fractional shortening values over time was noted in patients in Group A (p<0.001). The slight increase in ejection fraction and fractional shortening values in patients in Group B was not considered significant (p=0.216). The increase in ejection fraction rates in Groups C and D was significant (p=0.046 and p=0.047, respectively). The minimal increase in the fractional shortening values in Group B was significant (p=0.045).
Conclusion: Pulmonary valve-sparing surgical technique should be preferred in suitable patients. Close follow-up with echocardiography and cardiac magnetic resonance imaging is important for the monitoring of ventricular functions in patients with transannular patch application. However, pulmonary valve replacement is considered the primary treatment method.
Keywords : Homograft, pulmonary insufficiency, tetralogy of Fallot, transannular patch, xenograft