Open AccessTetralogy of Fallot: T-shaped infundibulotomy for pulmonary valve-sparing procedure
Author(s) -
Bertrand Léobon,
Grégoire Cousin,
Khaled Hadeed,
Sophie Breinig,
Xavier Alacoque,
Lionel Berthomieu,
Clément Karsenty
Publication year - 2021
Publication title -
interactive cardiovascular and thoracic surgery
Language(s) - English
Resource type - Journals
eISSN - 1569-9293
pISSN - 1569-9285
DOI - 10.1093/icvts/ivab275
Subject(s) - medicine , tetralogy of fallot , pulmonary valve , cardiology , ventricular outflow tract , commissurotomy , pulmonary atresia , surgery , pulmonary regurgitation , pulmonary valve stenosis , pulmonary valve insufficiency , ross procedure , stenosis , pulmonary artery , heart disease , aortic valve replacement
This new and easily reproducible pulmonary valve-sparing technique for the correction of Tetralogy of Fallot is based on a conservative management of the native pulmonary valve to preserve its growth potential. From July 2015 to December 2019, 67 children presenting with a Tetralogy of Fallot were operated consecutively in a single centre using this technique in all cases. A T-shaped infundibulotomy is used to release the anterior pulmonary annulus from any muscular attachment. After myocardial resection and ventricular septal defect closure, an extensive commissurotomy is achieved. Finally, the right ventricular outflow tract remodelling is completed by a shield-shaped bovine patch with an oversized square superior edge, attached directly on the pulmonary valve annulus, with an effect of systolic traction. Sixty patients (89.5%) had a Tetralogy of Fallot repair with preservation of the pulmonary valve. To date, with a median follow-up of 38.2 [14–64] months, no patient has needed a surgical or interventional procedure for pulmonary valve stenosis or regurgitation, with low residual gradients. This procedure could provide a significant increase in native pulmonary valve preservation. Long-term studies are needed to assess pulmonary valve growth and the consequent reduction in surgical or interventional reoperations.