Supervisors info:
Κωνσταντίνος Π. Τούτουζας, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ελένη Κυρίτση, Καθηγήτρια, Τμήμα Νοσηλευτικής, Πανεπιστήμιο Δυτικής Αττικής
Δημήτριος Τούσουλης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Background: Development of pulmonary insufficiency (PI) inpatients with surgically corrected Tetralogy of Fallot (TOF) may finally lead to severe right heart failure with serious consequences.
Purpose of the study. The aim of the present study is the evaluate the function and the architecture of the right ventricle after pulmonary valve replacement (PVR) in patients with surgically corrected tetralogy of Fallot.
Material and Methods: The sample of the present study includes, 51patients, who underwent PVR after the surgical correction of tetralogy and were followed over a period of 3,6±2.06 years.
Results: Of the 51 participants in the study 62,7 were males . Mean age of the sample was 33,41±8,38 years. All of them underwent redo PVR and 72,5% tricuspid valve repair, resection of right ventricular outflow tract aneurysms in 92,1%, enlargement of stenotic pulmonary arteriew in 9,8%,and in smaller numbers different concomitant procedures.
Mean hospital stay was 7,3 days and ICU stay was 1,8 days.
There was no intraoperative death. Implantation of permanent AICD in 3,9%, chronic atrial fibrillation occurred in 3,9% and atrial flutter in 1,9%.
Preoperative QRS duration was 147,47±13,58 msec. postoperatively was decreased significantly (p<0.05) in 139,69±12,90msec.
Patients who were in NYHA II , QRS duration was significantly decreased from 144,13 ±11,45 msec in 137,31±10,52 msec(p<0.05) and for patients in NYHAIII QRS duration decreased significantly from 160,63±9,0msec in 149,13±9,18 msec (p<0,05).
Enddiastolic vdimension of the right ventricle(RVEDD) was 37,60±2,84mm and decreased significantly to 31,00±2,88mm after redo PVR (p<0,05).
Specifically in patients who were preoperatively in NYHA II and III RVEDD decreased substantially (p<0,05) from 36,71±1,28 mm in 30,50±1,28mm and from 40,5±1,67mm to 33,25±3,04 respectively.
Conclusions: The probability of reoperation inpatients with surgically corrected TOF increases with time due to the development of severe pulmonary valve insufficiency. Timely redo PVR is crucial for long-term survival as it prevents the development of right heart failure and its severe consequences. Current bioprosthetic valve technology in combination with the beating heart technique provides excellent short-term and immediate results.
