Fig. 8.1
Cryoablation is performed at the infundibular septum which is often the origin of the ventricular arrhythmias
Fig. 8.2
To avoid the perivalvular leakage, one end of the pledgetted suture is passed from the outside of the native wall, and another end of this suture is passed from the patch (just this stitch) at the transitional portions between the native pulmonary wall and the prosthetic patch, so that the pledget locates astride both the native tissue and the patch
Fig. 8.3
Two pledgetted sutures at the transitional portions (described at Fig. 8.2) and the four mattress sutures passed from the outside of the patch and then through the bioprosthesis cuff are all tied finally
Fig. 8.4
Tricuspid annuloplasty is performed using the tricuspid ring including edge-to-edge repair between anterior and septal leaflets anticipating the less possibility of tricuspid valve regurgitation in the future
8.3 Tricuspid Valve Regurgitation After TOF Repair
The positive role of the additional prophylactic tricuspid annuloplasty is unclear. Only two papers described regarding the need for tricuspid annuloplasty at the same time of PVR [40, 41]. The former stated tricuspid valve function improved to a similar degree with or without annuloplasty. The latter concluded concomitant tricuspid annuloplasty should not be considered based on tricuspid annular dilation alone. However, considering that tricuspid regurgitation may be secondary to RV dilatation not only from pulmonary valve regurgitation but from a structural valve abnormality related to the VSD patch at initial repair [14], we usually do tricuspid annuloplasty (including edge-to-edge repair between anterior and septal leaflets) in anticipation of the less possibility of tricuspid valve regurgitation even at the time of initial repair. We, like many other surgeons, use the three-dimensional tricuspid ring in adult patients because tricuspid regurgitation recurs in the long term after conventional Kay or DeVega procedure.
Conclusion
Pulmonary valve regurgitation, its assessment and indication, and surgical technique of pulmonary valve replacement for patients with repaired tetralogy of Fallot are mainly described in this chapter.
There have been several other issues, such as more sensitive indicators peculiar to each patient who require a pulmonary valve replacement, the essentially limited longevity of bioprostheses, the effectiveness of cardiac resynchronization therapy for patients who have biventricular dysfunction, and the need of implantable cardioverter-defibrillator.
Aortopathy (or aortic root dilatation), which is often observed in adult repaired TOF patients, is described in another chapter in this textbook.
Longitudinal and careful follow-up using developing (sometimes breakthrough) methods is mandatory to obtain a better quality of life as well as a longer life expectancy in repaired TOF patients.
References
1.
Lillehei CW, Cohen M, Warden HE, Read RC, Aust JB, DeWall RA, et al. Direct vision intracardiac surgical correction of the tetralogy of Fallot, pentalogy of Fallot, and pulmonary atresia defects. Report of first ten cases. Ann Surg. 1955;142:418–42.CrossRefPubMedPubMedCentral
2.
Matsuda H. Congenital heart disease—20 years after that. In: Kawada S, Hosoda Y, editors. Fifty years of history of the Japanese Association for Thoracic Surgery [in Japanese]. Japanese Association for Thoracic Surgery, Tokyo; 1997. p. 188–95. http://www.jatsoj.org/anniversary/50/pdf/188-195.pdf.
3.
4.
Masuda M, Kuwano H, Okumura M, Amano J, Arai H, Endo S, et al. Thoracic and cardiovascular surgery in Japan during 2013. Annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2015;63:670–701.CrossRefPubMedPubMedCentral
5.
6.
Koyak Z, Harris L, deGroot JR, Silversides CK, Oechslin EN, Bouma B, et al. Sudden cardiac death in adult congenital heart disease. Circulation. 2012;126:1944–54.
7.
Bradley E, Parker J, Novak E, Ludbrook P, Billadello J, Cedars A. Cardiovascular disease in late survivors of tetralogy of Fallot. Tex Heart Inst J. 2013;40:418–23.PubMedPubMedCentral
8.
9.
