The right ventricular outflow tract and ventricle septal defect is repaired through a ventriculotomy and pulmonary arteriotomy. An adultsize heterograft aortic valve patch sterilized with. Recent studies have shown a 2836% decrease in rv volume following pulmonary valve replacement pvr but no change in. In 1955, for the first time, intracardiac corrective surgery of tof was performed 2. Patch repair augmentation of the outflow tract is complete. Longterm importance of right ventricular outflow tract patch function in patients with pulmonary regurgitation the journal of thoracic and cardiovascular surgery. In addition, many patients need a pulmonary valve to reconstruct a hemodynamically incompetent native or conduit free outflow tract. This report summarizes institutional experience and. All patients, but one, had undergone transannular patch repair as their. Right ventricular outflow tract transannular patch placement. Biventricular outflow tract obstruction after a rastelli. Between january 1982 and march 1999, 19 patients 10 boys and 9 girls. These findings were not evident in cases of ps treated with valvotomy with comparable amount of pr. The right coronary artery was mobilized, transected, and reimplanted into the ascending aorta.
There has been significant growth of the branch pulmonary arteries. Following adequate rewarming, the patient is weaned from cardiopulmonary bypass. Reconstruction of right ventricular outflow and pulmonary. Homologous monocuspid valve patch in right ventricular. Lior sasson, sion houri, alona raucher sternfeld, ilan cohen, orit lenczner, edward l. The rvot right ventricular outflow tract is located between supraventricular crest and pulmonary valve. As for the good performance, availability and longevity, contegra is a biomaterial suitable for the right ventricular outflow tract reconstruction and for patch repair for ventricular septal.
Range of ventricular dimensions and function by steady. Longterm importance of right ventricular outflow tract. Tetralogy of fallot occurs when there is underdevelopment of the right ventricular infundibulum or conus. Right ventricular outflow tract tachycardia stanford health. Right ventricular outflow tract transannular patch placement without cardiopulmonary bypass. Surgical treatment of right ventricular outflow tract. Right ventricular rv dilatation following tetralogy of fallot tof repair is due to both pulmonary regurgitation and the size of the right ventricular outflow tract rvot patch. The present study aims to compare the outcomes of tof repair using polytetrafluoroethylene ptfe patch versus autologous glutaraldehyde fixed pericardial patch for rvot. Right ventricular outflow tract medical billing and coding. Right ventricular outflow tract rvot to pulmonary artery pa continuity reconstruction has become one of the most common surgical procedures for patients with a wide variety of congenital heart diseases. Homologous monocuspid valve patch in right ventricular outflow tract reconstruction article in the journal of cardiovascular surgery 421. Right ventricular dysfunction is due to the right ventricular outflow tract patch.
Longterm importance of right ventricular outflow tract patch function in patients with pulmonary regurgitation author links open overlay panel rajesh puranik md a b victor tsang md b c philip lurz md a b vivek muthurangu md a b sophie offen mbbs a alessandra frigiola md a b c wendy norman dcr a fiona walker md c philip bonhoeffer md a andrew m. A new technique to repair tetralogy of fallot or doubleoutlet right ventricle with an anomalous right coronary artery arising from the left anterior descending coronary artery and crossing the right ventricular outflow tract is described. May 27, 2016 an anatomic anomaly consisting of a ventricular septal defect, right ventricular outflow tract obstruction with resultant right ventricular hypertrophy, and dextroposition of the aorta was described by fallot in 1888. The rvot and pulmonary annulus are enlarged with a pericardial patch. When this was completed i then took a goretex patch and patched the pulmonary artery and right ventricular outflow tract anteriorly. Summary right ventricular outflow tract obstruction was relieved by placing outflow patches across the pulmonary annulus in 39 of 195 patients who. An in vitro study of the influence of monocusp patch size on. Right ventricular outflow tract patch reconstruction in anomalous origin of right coronary artery. Stenting of the right ventricular outflow tract as primary. Right ventricular outflow tract stenting in tetralogy of. Reconstruction of the right ventricular outflow tract with. From cambridge english corpus a discrete atrioventricular septum was seen, and there was no elongation of the outflow tract of the left ventricle. Surgery was performed by placing a bovine pericardial monocusp patch across the pulmonary annulus.
Here, we report on a successful surgical repair of a 19monthold boy with an annular right ventricular outflow tract obstruction after nontransannular patch repair of tetralogy of fallot s,d,i at 2 weeks of age without the use of an extracardiac conduit. Rv outflow tract patch dysfunction in repaired tof is responsible for higher endsystolic volumes and thus lower global measures of ventricular systolic function. Composite pericardial monocusp patch for the reconstruction of the right ventricular outflow tract. Percutaneous pulmonary valve implantation ppvi is nowadays an accepted treatment option to repair post. A preoperative transthoracic echocardiogram tte 1 year previously showed a stenotic native right ventricular outflow tract rvot and stenotic right ventricular rv to pulmonary artery pa conduit homograft. The commonly used transannular patch tap approach relieves the rvot obstruction at the expense of exposing the patient to acute and. Surgical technique for right ventricular outflow tract reconstruction. At reoperation, the right ventricular outflow tract obstruction was released completely and reconstructed using a monocusp ventricular outflow patch n 14, valved pericardial roll n 2, or. Right ventricular outflow tract strategies for repair of tetralogy of. Tetralogy of fallot comprises a spectrum of severity. The pulmonary stenosis and right ventricular outflow tract obstruction seen with tetralogy of fallot usually limits blood flow to the lungs. The most prominent developmental difference between atrio ventricular and outflow tract cushions is the population of the outflow tract by neural crest cells.
To characterize the range of biventricular size and function evaluated by steady. Right ventricular outflow tract transannular patch. Longterm importance of right ventricular outflow tract patch function. In the extreme situation, the right ventricular outflow tract is completely blocked off, in which case you have tetralogy of fallot with pulmonary atresia. The monocusp patch incorporates a molded sinus of valsalva designed according to a computeranalyzed study of the normal anatomy. Right ventricular outflow tract repair with a cardiac. Abstract a composite bovine pericardial monocusp patch was implanted in the right ventricular outflow tract of 30 dogs. Tetralogy of fallot with pulmonary atresia pseudotruncus arteriosus is a severe variant in which there is complete obstruction atresia of the right ventricular outflow tract, causing an absence of the pulmonary trunk during embryonic development. Intraoperative evaluation of tetralogy of fallot matthew jolley and james dinardo tetralogy of fallottof is classically described as a variably cyanotic lesion consisting of right ventricular outflow tract obstruction, vsd, overriding aorta, and right ventricular hypertrophy. It provides our approach to the management of symptomatic tetralogy of fallot in early infancy n180 and our selection criteria for bridging to complete repair by right ventricular outflow tract stenting.
Right ventricular outflow tract reconstruction for pulmonary. Right ventricular outflow tract reconstruction using a. We hypothesized that this technique is associated with durable relief of right ventricular outflow tract obstruction. Reoperation tients received a pericardial patch of the rvot. Pr and evidence of right ventricular rv dilatation at echocardiography undergo a right ventricular outflow tract rvot assessment with mri, tissue doppler imaging, and cardiopulmonary exercise test. The objective of this study was to assess whether contegra valved bovine conduit, implanted as monocuspid transannular patch, might be an interesting alternative to overcome. An in vitro study of the influence of monocusp patch size. The goretex patch was sewed in place with a running 4 0 prolene suture. Reconstruction of the right ventricular outflow tract with a transannular patch for ventricular tachycardia refractory to radiofrequency catheter ablation in a. Thus, the right ventricular outflow tract may be essential for right ventricular ejection and maintenance of right ventricular function.
Outflow definition in the cambridge english dictionary. An 11year experience with rvot transannular patch tap augmentation without the use of cardiopulmonary bypass offpump is reported. The valve was secured anteriorly to the goretex patch. Between 1964 and 1972, pericardium the right ventricular outflow tract in 7,and a residual mainly was used as patch material, and 252 paventricular septal defect in 2 patients. Use of an expanded polytetrafluoroethylene valved patch. The mobilized right coronary artery long arrow, the ligation of the right coronary artery origin short arrow. A porcine cecm patch or dacron patch was used to reconstruct a fullthickness right ventricular outflow tract rvot defect in a rat model with end points of structural remodeling function at 16 weeks. Right ventricular outflow tract transannular patch placement without. Biventricular outflow tract obstruction after a rastelli rep. We describe a rare instance of a patient who developed an rvot aneurysm after trans ventricular repair of tetralogy of fallot, which was complicated with. A new composite xenograft monocusp patch for reconstruction. From september 1996 to december 1998, twentyfive patients, 4 months to 8 years of age median 10. Cardiac catheterization and angiography revealed moderate pulmonary insuf ficiency in all patients, a residual pressure gradient in the right ventricular outflow tract in.
Repair of hypoplastic right ventricular outflow tract. The outflow tract is derived from the secondary heart field, during cardiogenesis. Murphy, jg, gersh, bj, mair, dd, fuster, v, mcgoon, md, ilstrup, dm. Numerous materials have been used for reconstruction of the right ventricular outflow tract rvot in patients with complex congenital heart defects.
Right ventricular outflow tract obstruction radiology key. Right ventricular outflow tract patch reconstruction in. For patients of tof with pulmonary annular hypoplasia, reconstruction of right ventricular outflow tract rvot often requires a trans annular patch tap. The surgical management of rvot and the prosthetic material for rvot reconstruction remain controversial. A preliminary report article pdf available in cardiovascular diseases 71. Puranik r1, tsang v, lurz p, muthurangu v, offen s, frigiola a, norman w, walker f, bonhoeffer p, taylor am. Right ventricular outflow tract and pulmonary valve repair in patients with tetralogy of fallot using a bicuspid porcine pulmonary prosthesis is a simple, reliable procedure with good.
Right ventricular outflow tract rvot tachycardia litfl. Tetralogy of fallot, right ventricular outflow tract, patch material 1. Of the outflow tract tachycardias, the right ventricular outflow tract tachycardias rvot are the most common. The left ventricular outflow tract lvot, which connects to the aorta, is nearly indistinguishable from the rest of the ventricle. Stenting of the right ventricular outflow tract heart. It demonstrates that right ventricular outflow stenting is an effective bridging procedure allowing somatic and pulmonary artery growth. Among 1,022 patients who underwent repair of tetralogy of fallot, 252 received a pericardial patch of the right ventricular outflow tract. Mar 16, 2019 right ventricular outflow tract rvot tachycardia is a form of monomorphic vt originating from the outflow tract of the right ventricle or occasionally from the tricuspid annulus. Longterm importance of right ventricular outflow tract patch function in patients with pulmonary regurgitation. Chronic pulmonary regurgitation pr has deleterious effects on right ventricular rv function in repaired tetralogy of fallot tof. A patch across the pulmonary valve annulus a transannular patch is often required in order to adequately relieve right ventricular outflow tract obstruction. Those patients who were symptomatic and showed reduced exercise capacity were selected for surgery. The subaortic area was narrowed causing left ventricular outflow tract obstruction lvoto. Corrected transposition of the great arteries thoracic key.
Eleven infant goats group a and 12 infant sheep group b underwent rvot reconstruction under cardiopulmonary bypass. It leads to rv dysfunction and may require reoperation. Pediatric diminutive right ventricular outflow tract rvot reconstruction with homografts or porcine xenografts remains challenging because of limited availability, early degeneration, tissue ingrowth, and child growth. For relief of right ventricular outflow tract obstruction in the operative treatment of tetralogy of fallot and other complex congenital heart disease, it is often necessary to perform transannular monocusp patch to prevent right ventricular pressure overload and reduce pulmonary regurgitation. Introduction of all the cyanotic heart conditions, tetralogy of fallot tof is the most common which is found in 3.
Expanded polytetrafluoroethylene valved conduit and patch. By contrast, in the fmr group, the main cause of reoperation was not lvoto, but right ventricletopulmonary artery conduit stenosis n2, severe pulmonary regurgitation combined with a right ventricular outflow tract rvot aneurysm n1, a neoaorta stenosis after an arterial switch operation n1, an ascending aortic aneurysm n1 and pacemaker failure n1. In the presence of right heart hypertension, the chance of late development of a pericardial outflow tract aneurysm can be reduced further by attaching a synthetic patch to the surface of the previously placed pericardial patch. Reconstruction of the right ventricular outflow tract with a. In children with pulmonary atresia not amenable to initial complete correction, antegrade pulmonary blood flow can be established with surgical. It is only recently that several groups have revisited stenting the right ventricular outflow tract 9 12 in the initial palliation of symptomatic patients, including neonates. The present study aims to compare the outcomes of tof repair using polytetrafluoroethylene ptfe patch versus autologous glutaraldehyde fixed pericardial patch for rvot reconstruction.
The size of the patch is large enough to avoid residual blockage in the outflow tract but is not excessive. A new composite xenograft monocusp patch for reconstruction of the right ventricular outflow tract. Conduit reconstruction of right ventricular outflow tract. The right ventricular outflow tract and ventricle septal. Aneurysm of pericardial right ventricular outflow tract. Right ventricular outflow tract aneurysm with thrombus. The right ventricular outflow tract rvot is an infundibular extension of the ventricular cavity that connects to the pulmonary artery. A patch with 2 sinuses and a bicuspid valve is useful for augmentation of the narrow pulmonary annulus or reconstruction of the right ventricular outflow tract during the ross procedure. Right ventricular outflow tract obstruction thoracic key. Right ventricular outflow tract reconstruction with contegra. Postsurgical pseudoaneurysm of the right ventricular outflow tract.
However, the favorable experience with this heterograft in the pulmonary outflow tract makes us optimistic about its durability in the venous system. Surgical management of left ventricular outflow tract. The commonly used transannular patch tap approach relieves the rvot obstruction at the expense of exposing the patient to acute and chronic volume overload, resulting in late right ventricular rv dysfunction and reoperation for pv implantation 5. Tetralogy of fallot may be associated with chromosomal abnormalities, such as 22q11 deletion syndrome. The right ventricular hypertrophy occurs secondary to high pressure in the right ventricle rv, created by the pulmonary stenosis and the large vsd. A new technique to repair tetralogy of fallot or double outlet right ventricle with an anomalous right coronary artery arising from the left anterior descending. These children usually present with mild to moderate cyanosis and may have intermittent hypoxic spells. Right ventricular dysfunction due to right ventricular. The rv blood flow is redirected using an extra cardiac conduit yellow tubular structure into the pulmonary artery pa.
The vsd was closed with a pericardial patch red area, and left ventricular outflow tract lvot was reconstructed to redirect the blood flow from the left ventricle lv to the aorta. Bove, livia kapusta, akiva tamir, right ventricular outflow tract strategies for repair of tetralogy of fallot. Rv outflow tract patch dysfunction in repaired tof is responsible for higher end systolic volumes and thus lower global measures of ventricular systolic function. However, there are little data regarding right ventricular outflow tract rvot contractile dysfunction in response to chronic pr and on both rv and lv volumes and function. Reconstruction of rv outflow tract repair of the right ventricular outflow tract resulted in pulmonary valvular insuf ficiency, and the patient could not be taken off the pump oxygenator.
The dacron patch was encapsulated by dense fibrous tissue and showed little cellular infiltration. Polytetrafluoroethylene patch versus autologous pericardial. The biventricular repair approach is utilized if there is mild right ventricular and tricuspid valve hypoplasia without ventriculocoronary connections and without right ventricular outflow tract obstruction. Outflow meaning in the cambridge english dictionary. Longterm results of right ventricular outflow tract. Right ventricular outflow tract rvot aneurysm is a known complication of tetralogy of fallot repair when a ventriculotomy is done. Right ventricular outflow tract medical billing and. Right ventricular outflow tract strategies for repair of. Right ventricular outflow tract patch reconstruction in anomalous. Sep 20, 2017 percutaneous pulmonary valve implantation ppvi is nowadays an accepted treatment option to repair post. These tachycardias have a typical characteristic ecg appearance with a left bundle branch block appearance and are positive in the inferior leads of the ecg. A ventricular outflow tract is a portion of either the left ventricle or right ventricle of the heart through which blood passes in order to enter the great arteries the right ventricular outflow tract rvot is an infundibular extension of the ventricular cavity that connects to the pulmonary artery. From november 1980 to may 1982, 19 patients underwent surgery in this institution for right ventricular outflow tract obstruction.
It is usually seen in patients without underlying structural heart disease, although may also occur in the context of arrhythmogenic right ventricular dysplasia arvd. We examined the feasibility of using a polytetrafluoroethylene membrane goretex valve and transannular patch tap for right ventricular outflow tract rvot reconstruction in growing animal models. But the the geometric relationship between a monocusp patch length and the size of. Right ventricular outflow tract prosthesis in total. Longterm importance of right ventricular outflow tract patch. Expanded polytetrafluoroethylene monocuspid valve for.
Right ventricular outflow tract reconstruction with contegra monocuspid transannular patch in tetralogy of fallot author links open overlay panel bruno chiappini md, phd a catherine barrea md b jean rubay md, phd a. The transected right coronary was reimplanted into the ascending aorta long arrow, the incision in the right ventricular outflow tract was enlarged using a patch short arrow. Rvot right ventricular outflow tract atlas of human. In children with pulmonary atresia not amenable to initial complete correction, antegrade pulmonary blood flow can be established with surgical right ventricular outflow tract rvot patch enlargement. Biventricular response after pulmonary valve replacement for.
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