초록접수 현황
| 17F-230 | 구연 발표 |
How Small is too Small for Pulmonary Valve Annulus Preservation in the Repair of ToF?
Donghee Kim, Chun Soo Park, Eun Seok Choi, Bo Sang Kwon, Won Kyoun Park, Won Young Lee, Tae-Jin Yun
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
Purpose : We hypothesized that lower limits of pulmonary valve annulus (PVA) dimension upon PVA preservation in ToF are far smaller than expected.
Methods : From January 2016 to July 2017, 58 infants with ToF underwent primary repair (n=54) or repair after systemic-pulmonary shunt (n=4). Median age and body weight, and PVA(Z) at repair were 165 days, 7.4 kg and -1.8, respectively.
Results : PVA preservation was achieved in 55 patients (55/58, 94.8%). Surgical interventions on the pulmonary valve (PV) at repair comprised extensive commissurotomy with or without bougination in 41, transannular patching (TAP) in 3, and no intervention on the PV in 14. Median PVA dimension measured by Hegar dilator upon PVA preservation was 8 mm (IQR: 7-9 mm), which was 3.9 mm (IQR: 2.3-4.3 mm) smaller than normal PVA size for each patient. On immediate postoperative echocardiography, median RVOT velocity was 2.6 m/sec (IQR: 2.1-2.9 m/sec), and no patient was found to have pulmonary regurgitation (PR) equal to or greater than moderate grade except for three patients with TAP. In patients with no intervention on the PV (n=14), median RVOT velocity was 2.3 m/sec and PR was null on immediate postoperative echocardiography. Median follow up duration was 322 days (IQR: 152-451 days). During the follow-up, four patients underwent intervention for RVOT obstruction (n=3) or left pulmonary artery stenosis (n=1). Freedom from significant PR at 6 months after repair was 92%.
Conclusion : Preservation of PVA can be achieved in most of the patients with marginally small PVA with excellent early outcomes.
Methods : From January 2016 to July 2017, 58 infants with ToF underwent primary repair (n=54) or repair after systemic-pulmonary shunt (n=4). Median age and body weight, and PVA(Z) at repair were 165 days, 7.4 kg and -1.8, respectively.
Results : PVA preservation was achieved in 55 patients (55/58, 94.8%). Surgical interventions on the pulmonary valve (PV) at repair comprised extensive commissurotomy with or without bougination in 41, transannular patching (TAP) in 3, and no intervention on the PV in 14. Median PVA dimension measured by Hegar dilator upon PVA preservation was 8 mm (IQR: 7-9 mm), which was 3.9 mm (IQR: 2.3-4.3 mm) smaller than normal PVA size for each patient. On immediate postoperative echocardiography, median RVOT velocity was 2.6 m/sec (IQR: 2.1-2.9 m/sec), and no patient was found to have pulmonary regurgitation (PR) equal to or greater than moderate grade except for three patients with TAP. In patients with no intervention on the PV (n=14), median RVOT velocity was 2.3 m/sec and PR was null on immediate postoperative echocardiography. Median follow up duration was 322 days (IQR: 152-451 days). During the follow-up, four patients underwent intervention for RVOT obstruction (n=3) or left pulmonary artery stenosis (n=1). Freedom from significant PR at 6 months after repair was 92%.
Conclusion : Preservation of PVA can be achieved in most of the patients with marginally small PVA with excellent early outcomes.
첨부파일 : Abstract - Figure.pptx
책임저자: Tae-Jin Yun
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
발표자: Donghee Kim, E-mail : iclid@naver.com