scispace - formally typeset
Search or ask a question
Journal Article•DOI•

Pulmonary Valve Replacement in Repaired Tetralogy of Fallot Through Limited Left Anterolateral Thoracotomy: An Alternative to Repeat Sternotomy.

Tarun Raina Ramman, Kuntal Roy Chowdhuri, Nayem Raja, Sumir Girotra, Sushil Azad, Parvathi U Iyer, Krishna S Iyer 
15 Apr 2020-World Journal for Pediatric and Congenital Heart Surgery (SAGE PublicationsSage CA: Los Angeles, CA)-Vol. 11, Iss: 3, pp 346-349
TL;DR: It is reported that two patients with repaired tetralogy of Fallot who underwent pulmonary valve replacement through a limited left anterolateral thoracotomy reliably avoids the risk of cardiac injury during repeat sternotomy and appears to be safe, simple, and reproducible.
Abstract: We report two patients with repaired tetralogy of Fallot who underwent pulmonary valve replacement through a limited left anterolateral thoracotomy. We describe the technique in detail. Both patients were at risk of cardiac injury during repeat sternotomy. This approach reliably avoids the risk of cardiac injury during repeat sternotomy and appears to be safe, simple, and reproducible.
References
More filters
Journal Article•DOI•
Relation between right ventricular enlargement, QRS duration, and right ventricular function in patients with tetralogy of Fallot and pulmonary regurgitation after surgical repair

[...]

M.Y. Abd El Rahman, Hashim Abdul-Khaliq, Michael Vogel, Vladimir Alexi-Meskishvili, Matthias Gutberlet, Peter E. Lange 
01 Oct 2000-Heart
TL;DR: There is a correlation between the right ventricular size obtained by three dimensional echocardiography and QRS duration on the surface ECG, indicating mechanoelectrical interaction.
Abstract: OBJECTIVE—In patients with repaired tetralogy of Fallot, to examine (1) a possible relation between right ventricular enlargement and QRS prolongation, and (2) the effect of right ventricular enlargement caused by pulmonary regurgitation on the right ventricular ejection fraction, evaluated by three dimensional echocardiography, and global function, evaluated by the myocardial performance index. DESIGN AND PATIENTS—40 patients with repaired tetralogy were studied. Right ventricular volumes were derived from three dimensional echocardiographic data after this method had been validated by comparison with magnetic resonance imaging in 21 patients. Ejection fraction was calculated from end diastolic and end systolic volumes. The Doppler derived myocardial performance index was measured in all patients. Measured data were correlated with QRS duration. SETTING—Tertiary cardiac centre for congenital heart disease. RESULTS—There was good agreement between three dimensional echocardiographic and magnetic resonance assessment of right ventricular volumes and ejection fraction. The z score of the right ventricular end diastolic volume and ejection fraction of all patients was 1.35 and −4.15, respectively. Patients with severe pulmonary regurgitation had a lower right ventricular ejection fraction (p < 0.01) and an increased myocardial performance index (p < 0.01) compared with patients with mild to moderate pulmonary regurgitation. The correlation between ejection fraction and right ventricular end diastolic volume was r = −0.35 (p < 0.05). The mean (SD) QRS duration was 131.89 (25.69) ms, range 80-180 ms. The correlation between QRS duration and right ventricular end diastolic volume was r = 0.6 (p < 0.01). CONCLUSIONS—There is a correlation between the right ventricular size obtained by three dimensional echocardiography and QRS duration on the surface ECG, indicating mechanoelectrical interaction. The severity of pulmonary regurgitation has a negative influence on right ventricular ejection fraction and combined systolic and diastolic global function, as assessed by myocardial performance. Keywords: tetralogy of Fallot; pulmonary regurgitation; right ventricular enlargement; QRS prolongation

156 citations

"Pulmonary Valve Replacement in Repa..." refers background in this paper

  • ...Pulmonary valve replacement is the recommended treatment option for progressive RV dilatation resulting from longstanding pulmonary regurgitation in patients with repaired ToF.1 Right ventricular dilation is associated with arrhythmia and long-term risk of mortality in postoperative TOF.2 The standard approach for PVR is through a repeat sternotomy and conventional CPB. Evidence of retrosternal adhesion of cardiac structures can make repeat sternotomy risky due to the possibility of cardiac entry and catastrophic hemorrhage3 and necessitates an alternative approach....

    [...]

  • ...Right ventricular dilation is associated with arrhythmia and long-term risk of mortality in postoperative TOF.(2) The standard approach for PVR is through a repeat sternotomy and conventional CPB....

    [...]

Journal Article•DOI•
Recent Development in Pulmonary Valve Replacement after Tetralogy of Fallot Repair: The Emergence of Hybrid Approaches.

[...]

Tariq Suleiman1, Clifford J. Kavinsky1, Clare Skerritt1, Damien Kenny1, Michael N. Ilbawi1, Massimo Caputo1 •
Rush University Medical Center1
02 Jun 2015-Frontiers in Surgery
TL;DR: The purpose of this review is to highlight the recent advances in the hybrid field of pulmonary valve replacement, summarizing the advantages and disadvantages of the “traditional” surgical and the new catheter-based techniques and discuss the direction future research should take to determine the optimal management for individual patients.
Abstract: In the current era approximately 90% of infants born with tetralogy of Fallot (ToF) are expected to live beyond 40 years of age making it the fastest growing population amongst patients with congenital heart disease. One of the most common late consequences after repair of ToF, is pulmonary valve regurgitation (PVR). Significant PVR results in progressive dilatation and dysfunction of the right ventricle, decrease in exercise tolerance, arrhythmias, heart failure, and increased risk of sudden death. The conventional approach of dealing with this problem is to perform pulmonary valve replacement using cardiopulmonary bypass (CPB) and cardioplegic arrest. However, this approach is associated not only with long operative times but also side effects related to the use of CPB. Development of percutaneous approaches to valve disease is one of the most exciting areas of research and clinical innovation in cardiovascular research. The main development has been that of transcatheter pulmonary valve replacement for the rehabilitation of conduits between the right ventricle and pulmonary artery in patients after surgery for ToF. However, with the percutaneous technique, a limited size of prosthesis can be inserted. Moreover, the technique does not offer the opportunity of treating additional defects that are frequently associated with severe PR, such as pulmonary artery dilatation, and it cannot be used in the significantly dilated native right ventricular outlet tract (RVOT). The advent of the hybrid surgical options for treating cardiac disease has integrated the techniques of interventional cardiology with the techniques of cardiac surgery to provide a form of therapy that combines the respective strengths of both fields. In this review, we present and compare recent advances in procedures to replace the pulmonary valve in patients with ToF presenting with severe PVR and dilated RVOT.

19 citations

"Pulmonary Valve Replacement in Repa..." refers background in this paper

  • ...Suleiman et al described a hybrid approach wherein the RVOT was plicated through a thoracotomy, and a transcatheter valve was delivered through a purse string in the RVOT.(6) The advantages of a thoracotomy approach are evident....

    [...]

  • ...The patient presented numerous challenges, including adherence of the RA to the back of the sternum and severe pectus excavatum deformity.5 Suleiman et al described a hybrid approach wherein the RVOT was plicated through a thoracotomy, and a transcatheter valve was delivered through a purse string in the RVOT.6 The advantages of a thoracotomy approach are evident....

    [...]

Journal Article•DOI•
Redo Sternotomy for Cardiac Reoperations Using Peripheral Heparin-Bonded Cardiopulmonary Bypass Circuits Without Systemic Heparinization: Technique and Results

[...]

Arun K. Singh1, Gary Stearns1, Andrew Maslow1, William C. Feng1, Carl Schwartz1 •
Brown University1
01 Apr 2011-Journal of Cardiothoracic and Vascular Anesthesia
TL;DR: This study shows that HBC without systemic heparinization during resternotomy can be used safely in complex redo cardiac surgery, allowing easy dissection, less likely injury to vital structures, and less bleeding without compromising the hemodynamics.

16 citations

Journal Article•DOI•
Pulmonary valve replacement through a left thoracotomy approach

[...]

James Barnard1, Andreas Hoschtitzky1, Ragheb Hasan1•
Manchester Royal Infirmary1
01 Jan 2012-The Annals of Thoracic Surgery
TL;DR: The first case, to the authors' knowledge, of pulmonary valve replacement being performed via a left thoracotomy approach in a patient with pectus excavatum who had 3 previous sternotomies is reported.

11 citations

"Pulmonary Valve Replacement in Repa..." refers background in this paper

  • ...The patient presented numerous challenges, including adherence of the RA to the back of the sternum and severe pectus excavatum deformity.(5) Suleiman et al described a hybrid approach wherein the RVOT was plicated through a thoracotomy, and a transcatheter valve was delivered through a purse string in the RVOT....

    [...]

Journal Article•DOI•
Pulmonary valve replacement through a left minithoracotomy: an alternate approach.

[...]

Faisal H. Cheema1, Elbert E. Heng2, Atiq Rehman2, Atiq Rehman3•
University of Maryland, Baltimore1, Columbia University2, Memorial Hospital of South Bend3
01 Nov 2014-The Annals of Thoracic Surgery
TL;DR: A left minithoracotomy was performed, and the pulmonary valve was replaced with a bioprosthesis using warm cardiopulmonary bypass, with a beating-heart technique, which is the first case of a pulmonary valve replacement through this approach.

7 citations

"Pulmonary Valve Replacement in Repa..." refers methods in this paper

  • ...Pulmonary valve replacement using mini-thoracotomy approach through the second intercostal space was reported by Cheema et al but in a primary case of infective endocarditis of the pulmonary valve.(4) Barnard and associates performed PVR using a left anterolateral thoracotomy incision in the fourth intercostal space in a patient with multiple previous sternotomies....

    [...]