Regurgitation through the morphologically pulmonary valve after additional aortopulmonary anastomosis

Although additional aortopulmonary anastomosis established by creating double outlet from the systemic ventricle and anastomosing the pulmonary trunk to the ascending aorta can undoubtedly provide an unobstructed outlet for the systemic ventricle, postoperative regurgitation of the morphologically pulmonary valve, if it occurs, may spoil the efficacy. To determine whether the pulmonary valve can be regurgitant, 11 patients undergoing this surgical option, six accompanying a Fontan-type operation and five associated with biventricular repair, were reviewed. Postoperative regurgitation was observed echocardiographically in five patients. One patient with severe pathologic changes of the valve showed progressive regurgitation, necessitating valve replacement two months after the aortopulmonary anastomosis. The other four patients, including one with slight thickening of the pulmonary leaflets, had previously undergone banding of the pulmonary trunk. Slight regurgitation in these cases appeared between one month and two years after the procedure, but then neither progressed nor regressed. Pathologic changes of the pulmonary valve, and previous banding, therefore, can be recognized as risk factors for postoperative regurgitation. The morphologically pulmonary valve, nonetheless, proved to be feasible for this surgical option unless it possessed severe organic changes.