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048 MID-TERM OUTCOME OF NEONATAL TRICUSPID VALVE PLASTY FOR PULMONARY ATRESIA AND INTACT VENTRICULAR SEPTUM: TOWARDS BIVENTRICULAR REPAIR

Ito, H ; Ota, N ; Murata, M ; Tosaka, Y ; Ide, Y ; Tachi, M ; Sugimoto, A ; Ogawa, H ; Sakamoto, K

Interactive CardioVascular and Thoracic Surgery, 2013, Vol. 17(suppl2), pp.S80-S80 [Periódico revisado por pares]

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  • Título:
    048 MID-TERM OUTCOME OF NEONATAL TRICUSPID VALVE PLASTY FOR PULMONARY ATRESIA AND INTACT VENTRICULAR SEPTUM: TOWARDS BIVENTRICULAR REPAIR
  • Autor: Ito, H ; Ota, N ; Murata, M ; Tosaka, Y ; Ide, Y ; Tachi, M ; Sugimoto, A ; Ogawa, H ; Sakamoto, K
  • É parte de: Interactive CardioVascular and Thoracic Surgery, 2013, Vol. 17(suppl2), pp.S80-S80
  • Descrição: Objectives: Biventricular repair is difficult to achieve in pulmonary atresia and intact ventricular septum (PA/IVS) with a dysplastic tricuspid valve. We have aggressively introduced tricuspid valve plasty (TVP) at initial operation towards biventricular repair. We sought to describe the follow-up data of neonatal TVP for PA/IVS. Methods: Retrospective chart review from 1998 to 2012 was performed. TVP combined resection of abnormal basal chordae, commissuroplasty with commissurotomy, chordae reconstruction including papillotomy or artificial chord, and leaflet extension with pericardium. Clinical outcome and echocardiographic data were collected. Results: Five patients with PA/IVS had TVP. Median age and body weight was 15 (range 7-28) days, and 3.3 kg (2.7 to 3.8) respectively at initial operation. Preoperative median right ventricular end diastolic volume was 84% of normal (38-109%) and tricuspid valve diameter z-score -3.6 (-4.1 to 0.9). All patients had dysplastic tricuspid valve with moderate to severe regurgitation. Four patients had valvotomy and systemic to pulmonary shunt. One patient had valvotomy. Three patients had additional atrial septal defect creation. All patients reached definitive repair. Four patients underwent re-TVP additionally, including artificial chordae ( n = 2) and leaflet extension ( n = 1) at the definitive repair. There were no deaths or reoperations (mean follow-up 5.1 ± 2.9 years). There was no severe tricuspid regurgitation. All patients were in New York Heart Association class I. Two cases had atrial septal defect, and oxygen saturation was 93% and 97% respectively. Conclusions: Neonatal tricuspid valve plasty for PA/IVS as a step towards biventricular repair resulted in favourable mid-term outcomes. Long-term outcome in quality of life needs to be evaluated and we have to compare this strategy to patients in whom a Fontan circulation was created.

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