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Barbara J.m. Mulder - One of the best experts on this subject based on the ideXlab platform.
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Opportunities in Pulmonary Valve Replacement.
Expert review of cardiovascular therapy, 2009Co-Authors: Thomas Oosterhof, Mark G. Hazekamp, Barbara J.m. MulderAbstract:Pulmonary regurgitation is the most important residual lesion after initial surgical correction for Pulmonary (sub)valvular stenosis in the early life of patients with tetralogy of Fallot or isolated Pulmonary stenosis. Symptomatic or asymptomatic patients with severe right ventricular dilatation due to Pulmonary regurgitation may benefit from Pulmonary Valve Replacement. Surgery is ideally performed before the right ventricle becomes irreversibly damaged as a result of longstanding volume overload. However, the beneficial effects must be weighed up against the problems associated with degradation of the allograft, which often result in (numerous) reoperations. Owing to the higher risk of thromboembolic events in mechanical prosthesis and the lifetime need for anticoagulation, allografts are the most widely used prosthesis. Degradation of the allograft often leads to reoperation, mostly 10-20 years after initial implantation. For a patient receiving his first allograft at 20 years of age, several reoperations will have to be performed later in life. Percutaneous Pulmonary Valve implantation has the potential to decrease the number of surgical reoperations.
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Long-term effect of Pulmonary Valve Replacement on QRS duration in patients with corrected tetralogy of Fallot
Heart (British Cardiac Society), 2006Co-Authors: Thomas Oosterhof, Folkert J. Meijboom, Hubert W. Vliegen, Aeilko H. Zwinderman, Berto J. Bouma, Barbara J.m. MulderAbstract:Objective: To analyse the long-term course of QRS duration after Pulmonary Valve Replacement in patients with a previous correction for tetralogy of Fallot. Setting: Tertiary referral centres. Methods: In a retrospective study, 99 adult patients with tetralogy of Fallot, who had undergone a first Pulmonary Valve Replacement late after initial total correction, were identified from the CONCOR (CONgenital CORvitia) registry. Computer-generated QRS durations were obtained from 12-lead electrocardiogram ECG reports in the medical records. A mixed linear regression model was used to analyse the course of QRS duration over time and to identify risk factors for increase in QRS duration over time. Composite end point was created from sudden cardiac death, ventricular tachycardia or implantable cardioverter–defibrillator discharge. Results: In total, 99 patients (57% men, mean (SD) age at Pulmonary Valve Replacement 29 (11) years) with a median follow-up of 4.9 (0.1–16) years were analysed. In patients with preoperative QRS Conclusion: In our study, we observed a decrease in QRS duration directly after surgery, followed by a steady increase, in patients with a preoperative QRS >150 ms. The beneficial effect of Pulmonary Valve Replacement on QRS duration was transient. The risk of developing ventricular arrhythmias after surgery was substantial when preoperative QRS was⩾180 ms, but mortality remained low.
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Pulmonary Valve Replacement in patients with tetralogy of Fallot and Pulmonary regurgitation: early surgery similar to optimal timing of surgery?
European heart journal, 2005Co-Authors: Ernst E. Van Der Wall, Barbara J.m. MulderAbstract:This editorial refers to ‘Remodelling of the right ventricle after early Pulmonary Valve Replacement in children with repaired tetralogy of Fallot: assessment by cardiovascular magnetic resonance’† by E.R. Valsangiacomo Buchel et al., on page 2721 Tetralogy of Fallot is the most common form of cyanotic congenital heart disease, with a prevalence of 0.26–0.8 per 1000 live births.1 Total repair for tetralogy of Fallot has been available for 50 years with a favourable outcome in most patients. Today, one is faced with an increasing number of patients with residual Pulmonary regurgitation. It was previously thought that Pulmonary regurgitation in Fallot patients was rather harmless. However, accurate measurements of right ventricular volumes using cardiovascular magnetic resonance (CMR) imaging have visualized important enlargement of the right ventricle in patients with severe Pulmonary regurgitation.2 Moreover, it has been recently demonstrated that Pulmonary regurgitation leads to progressive right ventricular dilatation and, with time, to right ventricular dysfunction, exercise intolerance, ventricular arrhythmias, and sudden death.3 Pulmonary Valve Replacement can be performed electively with little risk and may improve symptoms of right ventricular failure and provides excellent mid-term survival. The surgical procedure has a peri-operative mortality of 1–4% and a 10-year survival of 86–95%.4 Previous echocardiographic evaluation of right ventricular dimensions in children and adolescents showed a decrease in end-diastolic volume and end-systolic volume after Pulmonary Valve Replacement. However, in adults, radionuclide angiography measurements showed no effects of Pulmonary Valve Replacement on right ventricular volumes and ejection fraction. … *Corresponding author. Tel: +31 71 5262020, fax: +31 71 5248116. E-mail address : e.e.van\_der\_wall{at}lumc.nl
Ryuji Tominaga - One of the best experts on this subject based on the ideXlab platform.
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Pulmonary Valve Replacement long after repair of tetralogy of Fallot
General Thoracic and Cardiovascular Surgery, 2012Co-Authors: Yuichi Shiokawa, Hiromichi Sonoda, Yoshihisa Tanoue, Atsuhiro Nakashima, Takahiro Nishida, Ryuji TominagaAbstract:Purpose Pulmonary Valve Replacement long after repair of tetralogy of Fallot can improve cardiac function, functional status, and arrhythmia propensity. This has not been reported in Japan. We aim to evaluate the effects of Pulmonary Valve Replacement in repaired tetralogy of Fallot. Methods Nineteen patients underwent Pulmonary Valve Replacement after repair of tetralogy of Fallot, excluding Rastelli type operation, between August 1981 and August 2011. The results of the Pulmonary Valve Replacement were assessed by analyzing preoperative and postoperative cardiothoracic ratio, cardiac function, functional status, QRS duration and durability of the prosthetic Valves. Results There were neither operative nor late deaths. The Cardiothoracic ratio significantly improved from 61.0 ± 5.2 % preoperatively to 56.2 ± 4.8 % postoperatively ( P
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Pulmonary Valve Replacement long after repair of tetralogy of Fallot.
General thoracic and cardiovascular surgery, 2012Co-Authors: Yuichi Shiokawa, Hiromichi Sonoda, Yoshihisa Tanoue, Atsuhiro Nakashima, Takahiro Nishida, Ryuji TominagaAbstract:Purpose Pulmonary Valve Replacement long after repair of tetralogy of Fallot can improve cardiac function, functional status, and arrhythmia propensity. This has not been reported in Japan. We aim to evaluate the effects of Pulmonary Valve Replacement in repaired tetralogy of Fallot.
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Isolated Pulmonary Valve Replacement: analysis of 27 years of experience.
Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs, 2008Co-Authors: Shigehiko Tokunaga, Munetaka Masuda, Akira Shiose, Yukihiro Tomita, Shigeki Morita, Ryuji TominagaAbstract:The aim of this study was to investigate the longterm results of isolated Pulmonary Valve Replacement using xenobioprostheses or mechanical Valves. Twenty-four cases of isolated Pulmonary Valve Replacement carried out at Kyushu University Hospital between 1977 and 2004 were reviewed. Those undergoing Rastelli’s operation were excluded from this study. Bioprostheses were used in 18 patients and mechanical Valves in 6. There were no operative deaths. Two patients with mechanical Valves needed repeat Pulmonary Valve Replacement due to thrombosed Valves. The patients with bioprostheses had no need of repeat Replacement postoperatively. The cardiothoracic ratio significantly improved from 60.3% preoperatively to 55.4% postoperatively (P < 0.05), and the New York Heart Association (NYHA) class significantly improved from 2.0 preoperatively to 1.1 postoperatively (P < 0.05). The actuarial survival rate at 15 years was 92.3%. The Valve-related event-free ratio at 15 years was 85.7% in the bioprosthesis group and 66.7% in the mechanical Valve group, with no significant difference. Isolated Pulmonary Valve Replacement with bioprostheses or mechanical Valves can be safely done and showed satisfactory long-term results. The mechanical Valve group demonstrated a high ratio of thrombosed Valves. A bioprosthesis is recommended for Pulmonary Valve Replacement if a homograft is not available.
Thomas Oosterhof - One of the best experts on this subject based on the ideXlab platform.
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Opportunities in Pulmonary Valve Replacement.
Expert review of cardiovascular therapy, 2009Co-Authors: Thomas Oosterhof, Mark G. Hazekamp, Barbara J.m. MulderAbstract:Pulmonary regurgitation is the most important residual lesion after initial surgical correction for Pulmonary (sub)valvular stenosis in the early life of patients with tetralogy of Fallot or isolated Pulmonary stenosis. Symptomatic or asymptomatic patients with severe right ventricular dilatation due to Pulmonary regurgitation may benefit from Pulmonary Valve Replacement. Surgery is ideally performed before the right ventricle becomes irreversibly damaged as a result of longstanding volume overload. However, the beneficial effects must be weighed up against the problems associated with degradation of the allograft, which often result in (numerous) reoperations. Owing to the higher risk of thromboembolic events in mechanical prosthesis and the lifetime need for anticoagulation, allografts are the most widely used prosthesis. Degradation of the allograft often leads to reoperation, mostly 10-20 years after initial implantation. For a patient receiving his first allograft at 20 years of age, several reoperations will have to be performed later in life. Percutaneous Pulmonary Valve implantation has the potential to decrease the number of surgical reoperations.
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preoperative thresholds for Pulmonary Valve Replacement in patients with corrected tetralogy of fallot using cardiovascular magnetic resonance
Circulation, 2007Co-Authors: Thomas Oosterhof, Alexander Van Straten, Mark G. Hazekamp, Folkert J. Meijboom, Hubert W. Vliegen, Aeilko H. Zwinderman, Berto J. Bouma, Arie P.j. Van Dijk, Anje M. Spijkerboer, Albert De RoosAbstract:Background— To facilitate the optimal timing of Pulmonary Valve Replacement, we analyzed preoperative thresholds of right ventricular (RV) volumes above which no decrease or normalization of RV size takes place after surgery. Methods and Results— Between 1993 and 2006, 71 adult patients with corrected tetralogy of Fallot underwent Pulmonary Valve Replacement in a nationwide, prospective follow-up study. Patients were evaluated with cardiovascular magnetic resonance both preoperatively and postoperatively. Changes in RV volumes were expressed as relative change from baseline. RV volumes decreased with a mean of 28%. RV ejection fraction did not change significantly after surgery (from 42±10% to 43±10%; P=0.34). Concomitant RV outflow tract reduction resulted in a 25% larger decrease of RV volumes. After correction for surgical RV outflow tract reduction, higher preoperative RV volumes (mL/m2) were independently associated with a larger decrease of RV volumes (RV end-diastolic volume: β=0.41; P<0.001). Rece...
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Preoperative Thresholds for Pulmonary Valve Replacement in Patients With Corrected Tetralogy of Fallot Using Cardiovascular Magnetic Resonance
Circulation, 2007Co-Authors: Thomas Oosterhof, Alexander Van Straten, Mark G. Hazekamp, Folkert J. Meijboom, Hubert W. Vliegen, Aeilko H. Zwinderman, Berto J. Bouma, Arie P.j. Van Dijk, Anje M. Spijkerboer, Albert De RoosAbstract:Background— To facilitate the optimal timing of Pulmonary Valve Replacement, we analyzed preoperative thresholds of right ventricular (RV) volumes above which no decrease or normalization of RV size takes place after surgery. Methods and Results— Between 1993 and 2006, 71 adult patients with corrected tetralogy of Fallot underwent Pulmonary Valve Replacement in a nationwide, prospective follow-up study. Patients were evaluated with cardiovascular magnetic resonance both preoperatively and postoperatively. Changes in RV volumes were expressed as relative change from baseline. RV volumes decreased with a mean of 28%. RV ejection fraction did not change significantly after surgery (from 42±10% to 43±10%; P=0.34). Concomitant RV outflow tract reduction resulted in a 25% larger decrease of RV volumes. After correction for surgical RV outflow tract reduction, higher preoperative RV volumes (mL/m2) were independently associated with a larger decrease of RV volumes (RV end-diastolic volume: β=0.41; P
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Long-term effect of Pulmonary Valve Replacement on QRS duration in patients with corrected tetralogy of Fallot
Heart (British Cardiac Society), 2006Co-Authors: Thomas Oosterhof, Folkert J. Meijboom, Hubert W. Vliegen, Aeilko H. Zwinderman, Berto J. Bouma, Barbara J.m. MulderAbstract:Objective: To analyse the long-term course of QRS duration after Pulmonary Valve Replacement in patients with a previous correction for tetralogy of Fallot. Setting: Tertiary referral centres. Methods: In a retrospective study, 99 adult patients with tetralogy of Fallot, who had undergone a first Pulmonary Valve Replacement late after initial total correction, were identified from the CONCOR (CONgenital CORvitia) registry. Computer-generated QRS durations were obtained from 12-lead electrocardiogram ECG reports in the medical records. A mixed linear regression model was used to analyse the course of QRS duration over time and to identify risk factors for increase in QRS duration over time. Composite end point was created from sudden cardiac death, ventricular tachycardia or implantable cardioverter–defibrillator discharge. Results: In total, 99 patients (57% men, mean (SD) age at Pulmonary Valve Replacement 29 (11) years) with a median follow-up of 4.9 (0.1–16) years were analysed. In patients with preoperative QRS Conclusion: In our study, we observed a decrease in QRS duration directly after surgery, followed by a steady increase, in patients with a preoperative QRS >150 ms. The beneficial effect of Pulmonary Valve Replacement on QRS duration was transient. The risk of developing ventricular arrhythmias after surgery was substantial when preoperative QRS was⩾180 ms, but mortality remained low.
Folkert J. Meijboom - One of the best experts on this subject based on the ideXlab platform.
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Consequences of a selective approach toward Pulmonary Valve Replacement in adult patients with tetralogy of Fallot and Pulmonary regurgitation
The Journal of thoracic and cardiovascular surgery, 2008Co-Authors: Folkert J. Meijboom, Jolien W. Roos-hesselink, Jackie Mcghie, S.e.c. Spitaels, Ron T. Van Domburg, Lisbeth M.w.j. Utens, Maarten L. Simoons, Ad J.j.c. BogersAbstract:Objective The aim of the study was to assess the long-term results of a selective policy toward Pulmonary Valve Replacement in adult patients with repaired tetralogy of Fallot and severe Pulmonary regurgitation. Methods Sixty-seven patients with tetralogy of Fallot were followed up from 15 ± 3 years until 27 ± 3 years after surgery. Results Twenty-two patients had mild-to-moderate Pulmonary regurgitation. No significant changes occurred in the follow-up period. Of 45 patients with severe Pulmonary regurgitation and severe right ventricular dilatation, 28 (62%) remained free of symptoms and did not undergo Pulmonary Valve Replacement. No changes in right ventricular size or exercise capacity were found. In 3 (11%) of 28 patients, QRS duration increased to more than 180 ms. Seventeen patients had symptoms and underwent Pulmonary Valve Replacement: 9 (54%) of 17 patients improved clinically and echocardiographically, and QRS duration shortened postoperatively. Right ventricular dimensions did not regress despite Pulmonary Valve Replacement in 8 patients. Conclusion Refraining from Pulmonary Valve Replacement in asymptomatic patients led to no measurable deterioration in 25 (89%) of 28 patients. Referring symptomatic patients for Pulmonary Valve Replacement led to an improvement in 9 (53%) of 17 patients. In 11 (24%) of 45, a selective approach led to questionable or unsatisfactory results.
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preoperative thresholds for Pulmonary Valve Replacement in patients with corrected tetralogy of fallot using cardiovascular magnetic resonance
Circulation, 2007Co-Authors: Thomas Oosterhof, Alexander Van Straten, Mark G. Hazekamp, Folkert J. Meijboom, Hubert W. Vliegen, Aeilko H. Zwinderman, Berto J. Bouma, Arie P.j. Van Dijk, Anje M. Spijkerboer, Albert De RoosAbstract:Background— To facilitate the optimal timing of Pulmonary Valve Replacement, we analyzed preoperative thresholds of right ventricular (RV) volumes above which no decrease or normalization of RV size takes place after surgery. Methods and Results— Between 1993 and 2006, 71 adult patients with corrected tetralogy of Fallot underwent Pulmonary Valve Replacement in a nationwide, prospective follow-up study. Patients were evaluated with cardiovascular magnetic resonance both preoperatively and postoperatively. Changes in RV volumes were expressed as relative change from baseline. RV volumes decreased with a mean of 28%. RV ejection fraction did not change significantly after surgery (from 42±10% to 43±10%; P=0.34). Concomitant RV outflow tract reduction resulted in a 25% larger decrease of RV volumes. After correction for surgical RV outflow tract reduction, higher preoperative RV volumes (mL/m2) were independently associated with a larger decrease of RV volumes (RV end-diastolic volume: β=0.41; P<0.001). Rece...
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Preoperative Thresholds for Pulmonary Valve Replacement in Patients With Corrected Tetralogy of Fallot Using Cardiovascular Magnetic Resonance
Circulation, 2007Co-Authors: Thomas Oosterhof, Alexander Van Straten, Mark G. Hazekamp, Folkert J. Meijboom, Hubert W. Vliegen, Aeilko H. Zwinderman, Berto J. Bouma, Arie P.j. Van Dijk, Anje M. Spijkerboer, Albert De RoosAbstract:Background— To facilitate the optimal timing of Pulmonary Valve Replacement, we analyzed preoperative thresholds of right ventricular (RV) volumes above which no decrease or normalization of RV size takes place after surgery. Methods and Results— Between 1993 and 2006, 71 adult patients with corrected tetralogy of Fallot underwent Pulmonary Valve Replacement in a nationwide, prospective follow-up study. Patients were evaluated with cardiovascular magnetic resonance both preoperatively and postoperatively. Changes in RV volumes were expressed as relative change from baseline. RV volumes decreased with a mean of 28%. RV ejection fraction did not change significantly after surgery (from 42±10% to 43±10%; P=0.34). Concomitant RV outflow tract reduction resulted in a 25% larger decrease of RV volumes. After correction for surgical RV outflow tract reduction, higher preoperative RV volumes (mL/m2) were independently associated with a larger decrease of RV volumes (RV end-diastolic volume: β=0.41; P
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Long-term effect of Pulmonary Valve Replacement on QRS duration in patients with corrected tetralogy of Fallot
Heart (British Cardiac Society), 2006Co-Authors: Thomas Oosterhof, Folkert J. Meijboom, Hubert W. Vliegen, Aeilko H. Zwinderman, Berto J. Bouma, Barbara J.m. MulderAbstract:Objective: To analyse the long-term course of QRS duration after Pulmonary Valve Replacement in patients with a previous correction for tetralogy of Fallot. Setting: Tertiary referral centres. Methods: In a retrospective study, 99 adult patients with tetralogy of Fallot, who had undergone a first Pulmonary Valve Replacement late after initial total correction, were identified from the CONCOR (CONgenital CORvitia) registry. Computer-generated QRS durations were obtained from 12-lead electrocardiogram ECG reports in the medical records. A mixed linear regression model was used to analyse the course of QRS duration over time and to identify risk factors for increase in QRS duration over time. Composite end point was created from sudden cardiac death, ventricular tachycardia or implantable cardioverter–defibrillator discharge. Results: In total, 99 patients (57% men, mean (SD) age at Pulmonary Valve Replacement 29 (11) years) with a median follow-up of 4.9 (0.1–16) years were analysed. In patients with preoperative QRS Conclusion: In our study, we observed a decrease in QRS duration directly after surgery, followed by a steady increase, in patients with a preoperative QRS >150 ms. The beneficial effect of Pulmonary Valve Replacement on QRS duration was transient. The risk of developing ventricular arrhythmias after surgery was substantial when preoperative QRS was⩾180 ms, but mortality remained low.
Brian Kogon - One of the best experts on this subject based on the ideXlab platform.
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Leaving Moderate Tricuspid Valve Regurgitation Alone at the Time of Pulmonary Valve Replacement: A Worthwhile Approach.
The Annals of Thoracic Surgery, 2015Co-Authors: Brian Kogon, Makoto Mori, Bahaaldin Alsoufi, Kirk R. Kanter, Matthew E. OsterAbstract:Background Pulmonary Valve disruption in patients with tetralogy of Fallot and congenital Pulmonary stenosis often results in Pulmonary insufficiency, right ventricular dilation, and tricuspid Valve regurgitation. Management of functional tricuspid regurgitation at the time of subsequent Pulmonary Valve Replacement remains controversial. Our aims were to (1) analyze tricuspid Valve function after Pulmonary Valve Replacement through midterm follow-up and (2) determine the benefits, if any, of concomitant tricuspid annuloplasty. Methods Thirty-five patients with tetralogy of Fallot or congenital Pulmonary stenosis were analyzed. All patients had been palliated in childhood by disrupting the Pulmonary Valve, and all patients had at least moderate tricuspid Valve regurgitation at the time of subsequent Pulmonary Valve Replacement. Preoperative and serial postoperative echocardiograms were analyzed. Pulmonary and tricuspid regurgitation, along with right ventricular dilation and dysfunction were scored as 0 (none), 1 (mild), 2 (moderate), and 3 (severe). Right ventricular volume and area were also calculated. Comparisons were made between patients who underwent Pulmonary Valve Replacement alone and those who underwent concomitant tricuspid Valve annuloplasty. Results At 1 month after Pulmonary Valve Replacement, there were significant reductions in Pulmonary Valve regurgitation (mean 3 vs 0.39, p p p = 0.81). However, at latest follow-up (mean 7.0 ± 2.8 years), the degree of tricuspid regurgitation was significantly higher in the concomitant annuloplasty group (mean 1.87 vs 1.12, p = 0.005). Conclusions In patients with at least moderate tricuspid Valve regurgitation, significant improvement in tricuspid Valve function and right ventricular size occurs in the first postoperative month after Pulmonary Valve Replacement, irrespective of concomitant tricuspid Valve annuloplasty. The tricuspid Valve appears to function better over the midterm if annuloplasty is not performed.
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Left ventricular function improves after Pulmonary Valve Replacement in patients with previous right ventricular outflow tract reconstruction and biventricular dysfunction.
Texas Heart Institute journal, 2011Co-Authors: Colin E Kane, Brian Kogon, Katherine Rodby, Paul M. Kirshbom, Michael V. Mcconnell, Maria A. Pernetz, Wendy BookAbstract:Congenital heart defects that have a component of right ventricular outflow tract obstruction, such as tetralogy of Fallot, are frequently palliated in childhood by disruption of the Pulmonary Valve. Although this can provide an initial improvement in quality of life, these patients are often left with severe Pulmonary Valve insufficiency. Over time, this insufficiency can lead to enlargement of the right ventricle and to the deterioration of right ventricular systolic and diastolic function. Pulmonary Valve Replacement in these patients decreases right ventricular volume overload and improves right ventricular performance. To date, few studies have examined the effects of Pulmonary Valve Replacement on left ventricular function in patients with biventricular dysfunction. We sought to perform such an evaluation. Records of adult patients who had undergone Pulmonary Valve Replacement from January 2003 through November 2006 were analyzed retrospectively. We reviewed preoperative and postoperative echocardiograms and calculated left ventricular function in 38 patients. In the entire cohort, the mean left ventricular ejection fraction increased by a mean of 0.07 after Pulmonary Valve Replacement, which was a statistically significant change (P < 0.01). In patients with preoperative ejection fractions of less than 0.50, mean ejection fractions increased by 0.10. We conclude that Pulmonary Valve Replacement in patients with biventricular dysfunction arising from severe Pulmonary insufficiency and right ventricular enlargement can improve left ventricular function. Prospective studies are needed to verify this finding.
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Risk factors for early Pulmonary Valve Replacement after Valve disruption in congenital Pulmonary stenosis and tetralogy of Fallot
The Journal of thoracic and cardiovascular surgery, 2009Co-Authors: Brian Kogon, Kirk R. Kanter, Paul M. Kirshbom, Courtney Plattner, Traci Leong, Theresa Lyle, Staci Jennings, Michael V. Mcconnell, Wendy BookAbstract:Objective Congenital heart defects with a component of Pulmonary stenosis are often palliated in childhood by disrupting the Pulmonary Valve, either by means of dilation or excision. It is unclear what factors affect a patient's ability to tolerate long-term Pulmonary insufficiency before requiring Pulmonary Valve Replacement. We analyze potential factors that are related to the interval between Pulmonary Valve disruption and Pulmonary Valve Replacement. Methods One hundred seven patients were analyzed. They had a congenital diagnosis of Pulmonary stenosis or tetralogy of Fallot, had their first Pulmonary Valve Replacement between 2002 and 2008, and had a known interval between Pulmonary Valve disruption and Pulmonary Valve Replacement. The median age at the time of surgical intervention was 2 years for Pulmonary Valve disruption (range, 0–56 years) and 26 years for Pulmonary Valve Replacement (range, 1–72 years). The median interval was 23 years (range, 0–51 years). Potential related factors were sex, race, initial diagnosis and procedure, age at Pulmonary Valve disruption, prior shunt operation, presence of branch Pulmonary artery stenosis, and degree of Pulmonary regurgitation. Results As determined by using univariate analysis, male patients had a shorter interval than female patients (median, 16 vs 26 years; P = .01), and African American patients had a shorter interval than white patients (median, 16 vs 25 years; P = .049). A significant correlation was also identified between age at the time of Pulmonary Valve disruption and the subsequent interval to Pulmonary Valve Replacement. Overall, the interval tended to increase as age at disruption increased ( P P = .02), stenosis determined based on small branch Pulmonary artery diameter was correlated to a prolonged interval to Pulmonary Valve Replacement (P = .009). Initial diagnosis, prior palliative shunt operation, and degree of Pulmonary regurgitation had no effect on the interval between Pulmonary Valve disruption and subsequent Pulmonary Valve Replacement. As determined by using multivariate analysis, only male sex and small Pulmonary artery diameter remained significant factors. Conclusions Male sex appears to shorten the interval between Pulmonary Valve disruption and Pulmonary Valve Replacement, whereas small branch Pulmonary artery diameter appears to lengthen the interval. Knowing which factors are detrimental and which are protective might help identify patients who are prone to a more rapid progression of right heart failure from free Pulmonary insufficiency, possibly steering them toward more frequent follow-up or more aggressive heart failure medical regimens.
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Adult congenital Pulmonary Valve Replacement: a simple, effective, and reproducible technique.
Congenital heart disease, 2007Co-Authors: Brian Kogon, Kirk R. Kanter, Katherine Rodby, Paul M. Kirshbom, Teresa Lyle, Michael E. Mcconnell, Wendy BookAbstract:Pulmonary Valve Replacement is a relatively uncommon operation in adults, with the exception of those patients operated on previously for congenital heart disease. We present a technique for Pulmonary Valve Replacement and right ventricular outflow tract augmentation. It has been utilized in over 50 consecutive patients. This technique is simple, effective, and easily reproducible. The postoperative hemodynamics, echocardiographic data, and outcomes have been excellent.
