Evolving strategies for preserving the pulmonary valve during early repair of tetralogy of Fallot: Mid-term results Vladimiro L. Vida, MD, PhD, Alvise.

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Evolving strategies for preserving the pulmonary valve during early repair of tetralogy of Fallot: Mid-term results Vladimiro L. Vida, MD, PhD, Alvise Guariento, MD, Biagio Castaldi, MD, Matteo Sambugaro, MPH, Massimo A. Padalino, MD, PhD, Ornella Milanesi, MD, Giovanni Stellin, MD The Journal of Thoracic and Cardiovascular Surgery Volume 147, Issue 2, Pages 687-696 (February 2014) DOI: 10.1016/j.jtcvs.2013.10.029 Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Cartoon showing the balloon dilation technique: A, Protective commissurotomy; B, B′, balloon dilation of the pulmonary valve annulus; C, C′, status after balloon dilation showing the gap of pulmonary valve tissue after the dilation procedure; D, D′, leaflet delamination procedure (to increase the pulmonary valve coaptation surface); E, resuspension plasty (to avoid leaflet prolapse). The Journal of Thoracic and Cardiovascular Surgery 2014 147, 687-696DOI: (10.1016/j.jtcvs.2013.10.029) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Intraoperative images of a 3.5-month-old boy with tetralogy of Fallot showing the pulmonary valve preservation technique. A, The effective PV orifice; B, the protective commissurotomy (white arrow); C, balloon dilation of the PV (*, balloon catheter); D, PV after balloon dilation; E, PV leaflet delamination (black arrow); F, leaflet patch augmentation (black and white arrows) and resuspension. PV, Pulmonary valve; Ao, ascending aorta; LPA, left pulmonary artery; MPA, main pulmonary artery. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 687-696DOI: (10.1016/j.jtcvs.2013.10.029) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Linear regression analysis showing the correlation (P < .001) between the grade of pulmonary valve regurgitation (PVR) and right ventricular (RV) function at follow-up. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 687-696DOI: (10.1016/j.jtcvs.2013.10.029) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions