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Doppler evaluation of homograft valved conduits in children
J N Meliones1, A R Snider, E L Bove
1Department of Pediatrics, C.S. Mott Children's Hospital, Ann Arbor 48109-0204.
Insights
Homograft valved conduits show mild regurgitation and normal flow velocities in most pediatric patients immediately after surgery. Follow-up reveals some progression of regurgitation but generally stable flow characteristics in these cardiac conduits.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Medical Imaging
Background:
- Homograft valved conduits are used in pediatric cardiac surgery.
- Assessing their early and intermediate-term function is crucial for patient outcomes.
- Echocardiography is a key tool for evaluating conduit performance.
Purpose of the Study:
- To evaluate the immediate postoperative flow characteristics of homograft valved conduits.
- To assess the intermediate-term fate and functional changes of these conduits.
Main Methods:
- Two-dimensional and Doppler echocardiography were performed on 69 children with 71 homograft conduits.
- Examinations occurred in the immediate postoperative period (1-40 days) and at intermediate-term follow-up (6-25 months).
- Flow characteristics assessed included valve regurgitation and peak velocity.
Main Results:
- Immediately post-surgery, 62% of conduits had mild regurgitation; 35% had no regurgitation.
- 82% of valves showed normal peak velocity (<1.3 m/s) initially; none exceeded 2.6 m/s.
- At follow-up, 29% of patients showed progression of regurgitation, with one conduit exceeding 2.6 m/s peak velocity.
Conclusions:
- Homograft valved conduits generally exhibit acceptable flow characteristics in the early postoperative period.
- A subset of conduits demonstrates progression of regurgitation and increased peak velocity over intermediate-term follow-up.
- Regular echocardiographic monitoring is essential to track the performance of these cardiac conduits.
Abstract:
To assess the flow characteristics of homograft valved conduits in the immediate postoperative period, 69 children with 71 homograft conduits underwent 2-dimensional and Doppler echocardiographic examination at 1 to 40 days (mean 8) after surgery. Of the 71 conduits studied, 19 were aortic and 52 were pulmonary homograft valved conduits. Two aortic homograft valved conduits were inserted in the aortic position, whereas all remaining homografts were placed in the pulmonary position. On the immediate postoperative echocardiogram, 25 (35%) of the conduit valves had no regurgitation and 44 (62%) had 1+ (mild) regurgitation. Two pulmonary valved conduits (3%) in the pulmonary position had 2+ (moderate) regurgitation and right ventricular dimensions greater than 95% for body surface area. The peak velocity across the homograft valve was normal (less than 1.3 m/s) in 58 valves (82%). In the remaining 13 valves, peak velocity ranged from 1.4 to 2.6 m/s. No homograft valve had a peak velocity greater than 2.6 m/s in the immediate postoperative period. To assess the fate of homograft valved conduits in the intermediate-term follow-up period, 38 children with 38 conduits had a repeat echocardiogram at 6 to 25 months (mean 15 +/- 6) after surgery. Of the 38 conduits examined, 10 (26%) had no regurgitation, 25 (66%) had 1+ regurgitation and 3 (8%) had 2+ regurgitation. Progression of the amount of regurgitation occurred in 11 (29%) patients. At the follow-up examination, peak velocity was less than or equal to 1.4 m/s across 34 conduit valves, between 1.4 and 2.6 m/s across 3 valves and greater than 2.6 m/s across 1 valve.(ABSTRACT TRUNCATED AT 250 WORDS)