Home Journal Watch Growth of the Pulmonary Valve Annulus after the Modified Blalock-Taussig Shunt in Patients with Tetralogy of Fallot

Growth of the Pulmonary Valve Annulus after the Modified Blalock-Taussig Shunt in Patients with Tetralogy of Fallot

buy brand name provigil online Congenital Heart Disease
Vol.16, No.5, 2021, pp.433-441, doi:10.32604/CHD.2021.015770

architecturally Siraphop Thapmongkol, Jarun Sayasathid, Jessada Methrujpanont, Kanthachat Thatsakorn, Worawan Jittham, Suwanna Puitm, Methiniwiran Thapmongkol, Jule Namchaisiri

Abstract

buy Lyrica from canada Background

The surgical outcomes of tetralogy of Fallot (TOF) have evolved dramatically and have resulted in lower mortality rate. Currently, the many cardiac centers have a trend to early single-stage complete repair more than a staged repair. However, the patients who have an early primary repair were required transannular patch augmentation of a pulmonary valve frequently. This effect has been developed a chronic pulmonary insufficiency may lead to right ventricular dilation, dysfunction. In this era, the aim of treatment of TOF is attempted to preserve pulmonary valve annulus for prevent right ventricular dysfunction in the future. The systemic to pulmonary artery shunt is a palliative procedure or known as staged repair for symptomatic patients with TOF. The modified Blalock-Taussig shunt (mBTS) is the most useful systemic to pulmonary shunt and perform as an initial procedure before complete repair. The mBTS can provide increase pulmonary blood flow as well as improve oxygenation and also promote pulmonary artery (PA) growth. However, the effect of this procedure to promote growth of a pulmonary valve annulus is still debate. 

Objectives

To compare a growth of pulmonary valve annulus between after staged repair and primary repair in patients with TOF (without pulmonary atresia). 

Methods

A retrospective case-control study, review of patients with TOF underwent total repair at our hospitals from January 2005 and December 2017 was performed, a total number of 112 patients underwent TOF repair. Twenty-nine patients (26%) underwent a staged repair (mBTS group) and 83 (74%) underwent total repair only or primary repair (PR group). We evaluated diameter of pulmonary valve annulus by using echocardiography at the time of first diagnosis and before complete repair on both groups. 

Results

The age of diagnosis of mBTS group were younger than PR group (p = 0.011). Therefore, pulmonary valve annuls were smaller in mBTS group. (Z-score, −2.93 ± 1.42 vs. −1.89 ± 0.97; p = 0.001). However, the growth potential of pulmonary valve annulus was increase more than PR group significantly (Z-score, −1.46 ± 1.02 vs. −2.11 ± 1.19; p = 0.009) Even though a patent ductus arteriosus was found commonly in PR group (p = 0.018). Conclusions: Our results suggest the systemic to pulmonary shunt or mBTS can promote growth of pulmonary valve annulus in patients with TOF.

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Commentary

The optimal surgical strategy for symptomatic neonates and infants with TOF are still debated. The choice between with complete primary repair and staged palliation are still considered by many centers.   Early, complete repair is the initial choice of many larger volume centers with experienced teams. The palliative approach remains a preference in settings where neonatal surgery faces high risk.

The effect of initial palliation with a systemic to pulmonary shunt regarding to growth of the pulmonary arteries had been published but results in expansion of pulmonary valve annulus is the reason of this interesting research and could support palliation as preferred strategy in some cases.

To evaluate if a systemic to pulmonary artery shunt can promote the growth of pulmonary valve annulus, the authors reviewed 112 patients consecutive children undergoing tetralogy of Fallot repair over a 12 years period. The goal was to evaluate the annular diameters, and compare primary repair (83 (74%) to those that underwent a pallaitive stratergy. The conclusions of the study showed that pulmonary valve annulus were smaller in mBTS group. (Z-score,− 2.93 ± 1.42 vs. − 1.89 ± 0.97; p = 0.001) but the growth potential of pulmonary valve annulus was increase more than PR group significantly (Z-score, − 1.46 ± 1.02 vs. − 2.11 ± 1.19; p = 0.009) suggesting that the systemic to pulmonary shunt or can promote growth of pulmonary valve annulus in patients with TOF.

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