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Updated: May 11, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Optimal Size of Transannular Patches for Tetralogy of Fallot Repair
Fumiaki Shikata1, Norihiko Oka2, Toru Okamura3
1Department of Cardiovascular Surgery, Kitasato University Hospital, Kanagawa, Japan; Department of Cardiac Surgery, The University of Tokyo, Tokyo, Japan.
Background:
This study investigates factors preventing the emergence of pulmonary regurgitation (PR) after transannular patch (TAP) repair for tetralogy of Fallot (TOF) with a small pulmonary valve annulus (PVA) in the long term.
Methods:
Seventy-seven patients who underwent intracardiac repairs (ICR) with TAP using a monocusp for right ventricular outflow tract reconstruction for TOF at three institutions (2008-2023) were enrolled. Reconstructed PVA size was calculated using the formula: (width of TAP [mm] + native PVA [mm] ∗ 3.14) / 3.14. PR ≥ moderate on echocardiography was considered significant. Factors influencing PR emergence post-ICR were analysed using Cox proportional hazard analysis.
Results:
No deaths occurred post-ICR. The median age and weight at ICR were 239 days and 7.3 kg, respectively. The median preoperative native PVA Z score was -3.0 (IQR: -4.5 to -2.0), and the reconstructed PVA Z score was 0.6 (IQR: -0.3 to 1.6). Patients whose reconstructed PVA Z scores increased by ≥4 from preoperative values had a significantly higher cumulative PR ratio (57.6%) compared to those with an increase of <4 from preoperative values (30.1%) (p=0.03). Extensive TAP (reconstructed PVA Z scores ≥+4 from preoperative values) was identified as a risk factor for progressive PR in the multivariable analysis.
Conclusions:
Extensive TAP was a significant risk factor for progressive PR in the long-term. Patients whose reconstructed PVA Z scores increased by less than 4 from preoperative values demonstrated better cumulative PR ratios after ICR.
