Pulmonary Valve Repair for Patients With Acquired Pulmonary Valve Insufficiency Sameh M. Said, MD, Richard D. Mainwaring, MD, Michael Ma, MD, Theresa.

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Presentation transcript:

Pulmonary Valve Repair for Patients With Acquired Pulmonary Valve Insufficiency Sameh M. Said, MD, Richard D. Mainwaring, MD, Michael Ma, MD, Theresa A. Tacy, MD, Frank L. Hanley, MD The Annals of Thoracic Surgery Volume 101, Issue 6, Pages 2294-2301 (June 2016) DOI: 10.1016/j.athoracsur.2016.01.035 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Echocardiogram showing severe PV insufficiency. One of the PV leaflets is seen in the image. (AOV = aortic valve; MPA = main pulmonary artery; PR = pulmonary regurgitation; PV = pulmonary valve; RVOT = right ventricular outflow tract.) The Annals of Thoracic Surgery 2016 101, 2294-2301DOI: (10.1016/j.athoracsur.2016.01.035) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Patient underwent transannular patch repair with preservation of the PV leaflets. The patient returns with severe PV insufficiency. (B) Close up of the PV showing nicely formed leaflets with an anterior gap created by the transannular patch. (Ao = aorta; PV = pulmonary valve.) The Annals of Thoracic Surgery 2016 101, 2294-2301DOI: (10.1016/j.athoracsur.2016.01.035) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) The transannular patch is excised. A double pledgeted suture is placed above the commissure on each side. (B) The pledgeted suture is tied to create a neocommissure. (C) The transannular incision is closed. (Ao = aorta.) The Annals of Thoracic Surgery 2016 101, 2294-2301DOI: (10.1016/j.athoracsur.2016.01.035) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Postoperative echocardiogram showing trace PV insufficiency. (AOV = aortic valve; MPA = main pulmonary artery; PR = pulmonary regurgitation; PV = pulmonary valve; RVOT = right ventricular outflow tract.) The Annals of Thoracic Surgery 2016 101, 2294-2301DOI: (10.1016/j.athoracsur.2016.01.035) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Degree of PV insufficiency for the 13 patients with TOF preoperatively, postoperatively, and at follow-up. (PV = pulmonary valve; TOF = tetralogy of Fallot.) The Annals of Thoracic Surgery 2016 101, 2294-2301DOI: (10.1016/j.athoracsur.2016.01.035) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Degree of PV insufficiency for the 3 patients with critical PS. (PS = pulmonary insufficiency; PV = pulmonary valve.) The Annals of Thoracic Surgery 2016 101, 2294-2301DOI: (10.1016/j.athoracsur.2016.01.035) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Supplemental Fig a The Annals of Thoracic Surgery 2016 101, 2294-2301DOI: (10.1016/j.athoracsur.2016.01.035) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Supplemental Fig b The Annals of Thoracic Surgery 2016 101, 2294-2301DOI: (10.1016/j.athoracsur.2016.01.035) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Supplemental Fig c The Annals of Thoracic Surgery 2016 101, 2294-2301DOI: (10.1016/j.athoracsur.2016.01.035) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Supplemental Fig d The Annals of Thoracic Surgery 2016 101, 2294-2301DOI: (10.1016/j.athoracsur.2016.01.035) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Supplemental Fig e The Annals of Thoracic Surgery 2016 101, 2294-2301DOI: (10.1016/j.athoracsur.2016.01.035) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Supplemental Fig f The Annals of Thoracic Surgery 2016 101, 2294-2301DOI: (10.1016/j.athoracsur.2016.01.035) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Supplemental Fig g The Annals of Thoracic Surgery 2016 101, 2294-2301DOI: (10.1016/j.athoracsur.2016.01.035) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Supplemental Fig h The Annals of Thoracic Surgery 2016 101, 2294-2301DOI: (10.1016/j.athoracsur.2016.01.035) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Supplemental Fig i The Annals of Thoracic Surgery 2016 101, 2294-2301DOI: (10.1016/j.athoracsur.2016.01.035) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Supplemental Fig j The Annals of Thoracic Surgery 2016 101, 2294-2301DOI: (10.1016/j.athoracsur.2016.01.035) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Supplemental Fig k The Annals of Thoracic Surgery 2016 101, 2294-2301DOI: (10.1016/j.athoracsur.2016.01.035) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Supplemental Fig l The Annals of Thoracic Surgery 2016 101, 2294-2301DOI: (10.1016/j.athoracsur.2016.01.035) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Supplemental Fig m The Annals of Thoracic Surgery 2016 101, 2294-2301DOI: (10.1016/j.athoracsur.2016.01.035) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Supplemental Fig n The Annals of Thoracic Surgery 2016 101, 2294-2301DOI: (10.1016/j.athoracsur.2016.01.035) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions