Tetralogy of Fallot: T-shaped infundibulotomy for pulmonary valve-sparing procedure
Bertrand Leobon1, Grégoire Cousin1, Khaled Hadeed2
1Department of Congenital Cardiac Surgery, University Hospital of Toulouse, Toulouse, France.
Insights
This study introduces a new pulmonary valve-sparing technique for Tetralogy of Fallot repair in children. The method successfully preserved native pulmonary valves in most patients, avoiding reoperations for stenosis or regurgitation.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Cardiovascular Surgery
Background:
- Tetralogy of Fallot (TOF) is a complex congenital heart defect requiring surgical intervention.
- Traditional TOF repair often involves pulmonary valve replacement or reconstruction, leading to potential long-term complications.
- Preserving the native pulmonary valve is crucial for optimizing growth and reducing reinterventions in pediatric patients.
Purpose of the Study:
- To present a novel, reproducible pulmonary valve-sparing surgical technique for Tetralogy of Fallot.
- To evaluate the efficacy and safety of this technique in preserving native pulmonary valve function in pediatric patients.
- To assess the need for subsequent surgical or interventional procedures related to pulmonary valve function post-repair.
Main Methods:
- A consecutive series of 67 children with Tetralogy of Fallot underwent repair using a standardized pulmonary valve-sparing technique.
- The technique involves T-shaped infundibulotomy, myocardial resection, ventricular septal defect closure, extensive commissurotomy, and right ventricular outflow tract reconstruction with a specific bovine patch.
- Data collected included operative outcomes, pulmonary valve function, and need for reintervention during follow-up.
Main Results:
- Pulmonary valve preservation was achieved in 60 out of 67 patients (89.5%).
- Median follow-up was 38.2 months, with no patient requiring surgical or interventional procedures for pulmonary valve stenosis or regurgitation.
- Low residual gradients across the pulmonary valve were observed, indicating preserved function.
Conclusions:
- This pulmonary valve-sparing technique is effective and reproducible for Tetralogy of Fallot repair in children.
- The procedure demonstrates significant potential for native pulmonary valve preservation, reducing the likelihood of future reoperations.
- Long-term evaluation is necessary to confirm sustained pulmonary valve growth and the full impact on reducing reinterventional rates.
Abstract:
This new and easily reproducible pulmonary valve-sparing technique for the correction of Tetralogy of Fallot is based on a conservative management of the native pulmonary valve to preserve its growth potential. From July 2015 to December 2019, 67 children presenting with a Tetralogy of Fallot were operated consecutively in a single centre using this technique in all cases. A T-shaped infundibulotomy is used to release the anterior pulmonary annulus from any muscular attachment. After myocardial resection and ventricular septal defect closure, an extensive commissurotomy is achieved. Finally, the right ventricular outflow tract remodelling is completed by a shield-shaped bovine patch with an oversized square superior edge, attached directly on the pulmonary valve annulus, with an effect of systolic traction. Sixty patients (89.5%) had a Tetralogy of Fallot repair with preservation of the pulmonary valve. To date, with a median follow-up of 38.2 [14-64] months, no patient has needed a surgical or interventional procedure for pulmonary valve stenosis or regurgitation, with low residual gradients. This procedure could provide a significant increase in native pulmonary valve preservation. Long-term studies are needed to assess pulmonary valve growth and the consequent reduction in surgical or interventional reoperations.
