Pulmonary annulus growth after the modified Blalock-Taussig shunt in tetralogy of Fallot.

Abstract

BACKGROUND:

In tetralogy of Fallot (TOF), it is well known that postoperative pulmonary regurgitation reduces right ventricular function during long-term follow-up. Complete repair without a transannular patch should help avoid pulmonary regurgitation. Recently, primary complete repair has been preferred to the staged repair with use of a Blalock-Taussig shunt (BTS) even in neonates or small infants; however, little has been reported about the influence of a BTS on pulmonary annular growth.

METHODS:

We examined 40 patients with TOF or double-outlet right ventricle with pulmonary stenosis. Twenty-one patients received a BTS before complete repair, whereas 19 patients underwent primary complete repair. Pulmonary annular size was measured by echocardiography before BTS, complete repair, or both, and ventricular volume was measured by cardiac catheterization.

RESULTS:

There were no significant differences in complete repair age or body size between the groups. Pulmonary annulus sizes in the BTS group were smaller than those in the primary repair group (Z score, -5.1 ± 2.5 vs -3.7 ± 1.8). After the BTS, significant annular growth (Z score, -2.8 ± 2.1) was observed (p = 0.0028), with a significant increase in left ventricular end-diastolic volume (p = 0.015). When patients with severe pulmonary stenosis (Z score > -7.0) were excluded, pulmonary annular preservation at complete repair was achieved in 64.7% (11/17) of the BTS group and 36.8% (7/19) of the primary repair group (p = 0.088).

CONCLUSIONS:

The BTS increased the pulmonary annular size and the left ventricular volume during the 6 months before complete repair, resulting in preservation of the pulmonary valve function.

• Authors: Kouki Nakashima, Keiichi Itatani, Norihiko Oka, Tadashi Kitamura, Tetsuya Horai, Yosuke Hari, Kagami Miyaji
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 98 Issue 3 Pg. 934-40 (Sep 2014) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 25038019 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Blalock-Taussig Procedure
• Double Outlet Right Ventricle (complications)
• Humans
• Infant
• Pulmonary Valve (growth & development)
• Pulmonary Valve Stenosis (complications)
• Retrospective Studies
• Tetralogy of Fallot (complications, surgery)