Initial Experience With a Bicuspid Polytetrafluoroethylene Pulmonary Valve in 41 Children and Adults: A New Option For Right Ventricular Outflow Tract.

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Presentation transcript:

Initial Experience With a Bicuspid Polytetrafluoroethylene Pulmonary Valve in 41 Children and Adults: A New Option For Right Ventricular Outflow Tract Reconstruction James A. Quintessenza, MD, Jeffrey P. Jacobs, MD, Victor O. Morell, MD, Jorge M. Giroud, MD, Robert J. Boucek, MD The Annals of Thoracic Surgery Volume 79, Issue 3, Pages 924-931 (March 2005) DOI: 10.1016/j.athoracsur.2004.05.045

Fig 1 (A) A surgically prepared 0.6 mm PTFE bicuspid valve, with opposing attached leaflets that are shaped like a bishop's hat, is created. (B) The length of the free edge of the leaflets is approximately 1.5 times the diameter of the outflow tract or annulus upon completion. (C) This leaflet redundancy allows for adequate excursion of the leaflets and minimizes outflow tract gradients, while maximizing coaptation and competency of the valve. The Annals of Thoracic Surgery 2005 79, 924-931DOI: (10.1016/j.athoracsur.2004.05.045)

Fig 2 (A) A vertical right ventriculotomy is made and extended into the main pulmonary artery. (B) The superior margins of the leaflets usually are sewn to the true annulus but occasionally sewn slightly lower in the right ventricular outflow tract (RVOT) to allow for a larger prosthesis. A running polypropylene suture line attaches the posterior leaflet first. (C) Next, a running polypropylene suture line attaches the anterior leaflet. (D) The resultant pulmonary valve has redundant leaflets and a large wide-open orifice. (E) The remaining RVOT defect is closed with a transannular patch of treated pericardium or other suitable patch material. The Annals of Thoracic Surgery 2005 79, 924-931DOI: (10.1016/j.athoracsur.2004.05.045)

Fig 3 Patients experienced an improvement in New York Heart Association status from 1.9 to 1.1 (p < 0.001). ▥ = preoperative; ■ = latest follow-up. The Annals of Thoracic Surgery 2005 79, 924-931DOI: (10.1016/j.athoracsur.2004.05.045)

Fig 4 Pulmonary insufficiency (PI) improved significantly immediately postoperatively and was stable on most recent echocardiograms (preoperative [▥] PI = 3.2; latest follow-up [■] PI = 0.75, p < 0.001). The Annals of Thoracic Surgery 2005 79, 924-931DOI: (10.1016/j.athoracsur.2004.05.045)

Fig 5 Right ventricular end diastolic dimension (RVEDD) decreased significantly from preoperatively (PRE) to postoperatively (POST) (preoperative RVEDD = 32.52 mm, latest follow-up RVEDD = 27.97, p = 0.011). The Annals of Thoracic Surgery 2005 79, 924-931DOI: (10.1016/j.athoracsur.2004.05.045)