Homologous monocuspid valve patch in right ventricular outflow tract reconstruction

In the surgical repair of tetralogy of Fallot or pulmonary atresia, pulmonary regurgitation may be detrimental in the postoperative period. We have used homograft monocuspid valve patch to prevent pulmonary insufficiency.

From September 1996 to December 1998, twenty-five patients, 4 months to 8 years of age (median 10.1 months) had homograft monocuspid valve in the procedure of right ventricular outflow tract reconstruction. The function of the monocuspid valve was assessed by echocardiogram and graded as trivial to mild, mild to moderate, moderate, and severe. We evaluated the degree of pulmonary insufficiency before discharge, at 3-6 months, and at 12 months after the operation.

There was one hospital death due to fulminate adeno viral pneumonia. On echocardiogram, 21 patients (88%, 21/24) had no significant pulmonary insufficiency. Only one patient (4.5%) showed a moderate degree of pulmonary insufficiency. At 3-6 months, seventeen of twenty-one (81%) patients had no significant pulmonary insufficiency. There were fourteen patients who had follow-up over 1 year, and no patients showed newly developed significant pulmonary insufficiency.

We concluded that the homograft monocuspid valve patch for right ventricular outflow tract reconstruction has provided excellent early results for the prevention of pulmonary insufficiency. However these effects are limited in duration and further close follow-up should be needed.