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When do patients with Tetralogy of Fallot need a transannular patch
Zhangwei Wang1, Zhiqiang Li1, Nan Ding1
1Department of Cardiac Surgery, Beijing Children's Hospital, National Children's Medical Center, Capital Medical University, Beijing, China.
Journal of Cardiac Surgery
|November 15, 2022
Summary
Echocardiographic indicators like pulmonary valve annulus (PVA) prop and PVA index (PAI) effectively predict transannular patch (TAP) use in Tetralogy of Fallot (TOF) patients. These measures offer a simpler, more reliable alternative to the PVA Z-score for surgical planning.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Medical Imaging
Background:
- Tetralogy of Fallot (TOF) is a complex congenital heart defect requiring surgical intervention.
- Transannular patch (TAP) is a surgical technique used in TOF repair, but its necessity varies.
- Predicting the need for TAP is crucial for optimizing surgical outcomes in TOF patients.
Purpose of the Study:
- To assess the predictive value of echocardiographic parameters for TAP selection in TOF patients.
- To compare the efficacy of various indicators, including main pulmonary artery (MPA) Z-score, pulmonary valve annulus (PVA) prop, great aortic valve annulus (GA) ratio, PVA index (PAI), and PVA area index (PAAI).
Main Methods:
- Retrospective analysis of 247 pediatric TOF patients undergoing radical repair from 2010-2021.
- Patients were categorized into TAP (n=82) and non-TAP (n=165) groups based on intraoperative decisions.
- Echocardiographic measurements of PVA, aortic valve annulus, and MPA were used to calculate various Z-scores and indices.
Main Results:
- All evaluated echocardiographic parameters (PVA Z-score, MPA Z-score, PVA prop, GA ratio, PAI, PAAI) were significantly lower in the TAP group compared to the non-TAP group (p < .0001).
- Receiver-operating curve analysis identified cut-off values for each parameter, with PVA Z-score (-1.96), MPA Z-score (-1.04), PVA prop (0.37), GA ratio (0.64), PAI (0.78), and PAAI (0.4) demonstrating predictive capabilities.
- Pulmonary valve bicuspid malformation was noted as a factor potentially limiting predictive model accuracy.
Conclusions:
- PVA prop, GA ratio, PAI, and PAAI are reliable, convenient echocardiographic predictors for TAP selection in TOF, offering advantages over the PVA Z-score.
- PAI and PVA prop showed superior predictive efficacy compared to GA ratio and PAAI.
- Combining PAI or PVA prop with MPA Z-score can enhance predictive value; however, PV morphology and tissue characteristics should also be considered in surgical planning.
