Vladimiro L. Vida
University of Padua, Italy
Title: Preserving the pulmonary valve during early repair of tetralogy of Fallot: anatomical substrates and surgical strategies.
Biography
Biography: Vladimiro L. Vida
Abstract
Objective: To describe the anatomy of the PV in tetralogy of Fallot (ToF) and to define the influence of PV anatomy on the development of surgical techniques for PV preservation during early repair.
Methods: The PV was evaluated in 79 anatomical specimens of un-operated patients with ToF, and in 82 patients who underwent early ToF repair at our institution. New surgical techniques for PV preservation during early repair are described.
Results: The PV in ToF was predominantly bicuspid (n=118/160, 73.7%) less frequently tricuspid (n=28/160, 17.5%) and seldom unicuspid (n=14/160, 8.8%). In 82 cases (51.3%) the PV cusps were normal while in the remaining 78 cases (48.7%) they were thickened and dysplastic. The PV could be preserved in 46/82 (56%) consecutive patients during ToF repair in our more recent experience, using balloon dilation alone (18/46, 39%) or in association with other PV plasty maneuvers (28/46, 61%). Most bicuspid and tricuspid valves were salvageable but unicuspid valves were not suitable. After a median follow-up time of 2.8 years (range 0.5-6.8 years) the degree of PV regurgitation continued to be none/mild in 40 patients (86%) and was moderate in 6 (14%).
Conclusions: The majority of patients with ToF (>90%) have a bicuspid or a tricuspid PV, which represents the most favorable surgical anatomy for preserving the PV, independent of the presence or degree of leaflet dysplasia. The recent introduction of more complex PV plasty techniques, such as the delamination plasty, allowed us to further extend the applicability of PV preservation techniques.