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Repaired Tetralogy of Fallot and Branch Pulmonary artery Stenosis

Travis J Wilder, Glen S Van Arsdell, Eric Pham-Hung, Michael Gritti, Sara Hussain, Christopher A Caldarone, Andrew Redington, Edward J Hickey
BACKGROUND: Potential surgical strategies for hypoplastic branch pulmonary arteries (BPAs) during tetralogy of Fallot repair include (1) extensive patch augmentation to the hilum (PATCH), (2) limited extension arterioplasty to the proximal pulmonary artery (EXTENSION), or (3) leaving the native vessels unaugmented (NATIVE). We explored the effect of these strategies on reintervention and BPA growth. METHODS: From 2000 to 2012, 434 children underwent complete tetralogy of Fallot repair...
March 2016: Annals of Thoracic Surgery
Kuang-Jen Chien, Hurng-Wern Huang, Ta-Cheng Huang, Cheng-Liang Lee, Ken-Pen Weng, Chu-Chuan Lin, Po-Chuen Shieh, Ming-Ting Wu, Kai-Sheng Hsieh
PURPOSE: The aim of this study was to compare the usefulness of lung perfusion scintigraphy and echocardiogram in the evaluation of the branch pulmonary arteries stenosis in children with tetralogy of Fallot (TOF). MATERIALS AND METHODS: From February 2006 to November 2008, 74 children (mean age 7.8 years, range 1–18 years) who underwent repair of TOF at ages from 10 months to 13 years were suspected to have unilateral or bilateral branch pulmonary artery stenosis...
January 2016: Annals of Nuclear Medicine
Tingliang Liu, Ying Guo, Wei Gao, Meirong Huang, Yibei Wu, Zhiqing Yu
OBJECTIVE: The Pul-stent is a new cobalt alloys stent, specially licensed for pulmonary artery stenosis. The aim of this study was to investigate the value of the stent implantation as the treatment of postoperative pulmonary artery stenosis. METHOD: Clinical practice was carried out to evaluate effectiveness, safety and maneuverability of Pul-stent in the defined clinical setting. Transthoracic echocardiography, chest roentgenography and electrocardiography were carried out as follow-up studies at 1 and 3 months after procedures...
March 2015: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
Yoshihiro Honda, Shoji Suzuki, Shigeaki Kaga, Yukiyo Yoshida, Mitsuhiro Kimura, Kentaro Kamiya, Kenji Sakakibara, Masatake Katsu
The patient was diagnosed with tetralogy of Fallot associated with absent pulmonary valve syndrome and a low birth weight of 1,912 g. He suffered from respiratory distress on day 14 and received non-invasive positive pressure ventilation. At 5 months of age and 4.1 kg, he underwent intracardiac repair including right ventricular outflow repair with a monocusp patch, patch closure of the ventricular septum defect and right pulmonary transposition to the anterior of the ascending aorta following the Lecompte maneuver for airway decompression...
May 2015: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Shiraz A Maskatia, Shaine A Morris, Joseph A Spinner, Rajesh Krishnamurthy, Carolyn A Altman
BACKGROUND: Right ventricular (RV) dilation, RV dysfunction, RV outflow tract obstruction, and branch pulmonary artery stenosis are risk factors associated with the need for future surgical or catheter-based intervention commonly assessed by cardiac magnetic resonance in patients with tetralogy of Fallot who have undergone initial repair. The ability of echocardiography to predict the presence of these risk factors is limited. OBJECTIVE: We aimed to determine the association between echocardiographic parameters of right ventricular diastolic dysfunction and risk factors for intervention as identified on cardiac magnetic resonance imaging (CMR)...
May 2015: Congenital Heart Disease
Eleanor T Ross, John M Costello, Carl L Backer, Lynne M Brown, Joshua D Robinson
BACKGROUND: In symptomatic neonates with tetralogy of Fallot with pulmonary stenosis (TOF/PS), limited contemporary data exist regarding the effect of a modified Blalock-Taussig shunt (mBTS) on pulmonary valve (PV) and pulmonary artery (PA) growth and on the incidence of PV preservation at the time of complete repair. METHODS: We retrospectively studied patients who underwent repair of TOF/PS from 2000 to 2012 at our center. In neonates with TOF/PS palliated with an mBTS, we assessed PV annulus, main PA (MPA), and branch PAs (left PA [LPA] and right PA [RPA]) size by echocardiography before mBTS and surgical repair...
April 2015: Annals of Thoracic Surgery
Ying Guo, Zhiqing Yu, Tingliang Liu, Wei Gao, Meirong Huang, Fen Li, Lijun Fu, Pengjun Zhao
OBJECTIVE: Branch pulmonary artery stenosis is one of the common congenital heart disease. Stent implantation to relieve branch pulmonary artery stenosis (BPAS) is an alternative to failed surgical or balloon angioplasty. The aim of this study was to explore the indication, methods and complications of using balloon expandable stent placement to treat branch pulmonary artery stenosis, and evaluate the results of stent implantation in the treatment of branch pulmonary artery stenosis. METHOD: From August 2005 to December 2012, 19 patients underwent an attempt at stent implantation...
May 2014: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
Deepa Sasikumar, Bijulal Sasidharan, Jaganmohan A Tharakan, Baiju S Dharan, Thomas Mathew, Jayakumar Karunakaran
BACKGROUND AND OBJECTIVES: Repair of tetralogy of Fallot (TOF) with monocusp pulmonary valve reconstruction prevents pulmonary regurgitation (PR) for a variable period. Since postoperative outcome is governed by PR and right ventricular function, we sought to assess the severity of pulmonary regurgitation and right ventricular outflow (RVOT) gradient in the immediate postoperative period and at 1 year and attempted to identify the anatomical substrates responsible for adverse outcomes...
January 2014: Annals of Pediatric Cardiology
Anuradha Sridhar, Raghavan Subramanyan, Rajasekaran Premsekar, Shanthi Chidambaram, Ravi Agarwal, Soman Rema Krishna Manohar, K M Cherian
OBJECTIVE: Reconstruction of branch pulmonary arteries (PAs) can be challenging in redo congenital heart surgeries. Treatment options like percutaneous stent implantation and surgical patch angioplasty may yield suboptimal results. We present our experience with hybrid intraoperative stenting which may be an effective alternative option. METHODS: We retrospectively analyzed data of all patients with PA stenosis who underwent intraoperative PA branch stenting in our institution between January 2011 and December 2012...
January 2014: Indian Heart Journal
Narutoshi Hibino, Dingchao He, Feng Yuan, Jae-Hyeon Yu, Richard Jonas
BACKGROUND: The management of tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collateral arteries is controversial because of the wide variability of pulmonary artery (PA) and major aortopulmonary collateral arteries morphology. Several different staged strategies have been used to promote growth of diminutive PA branches. We have preferred a right ventricular (RV)-PA homograft for symmetrical growth of the central PA branches. In this study we evaluated the success of this strategy...
June 2014: Annals of Thoracic Surgery
Hyungtae Kim, Si Chan Sung, Yun Hee Chang, Hyoung Doo Lee, Ji Ae Park
OBJECTIVES: Postoperative left pulmonary artery (LPA) kinking is problematic in repair of tetralogy of Fallot (TOF). We used angioplasty of the proximal LPA with an anterior wall flap of the main pulmonary artery (MPA) to prevent this problem. METHODS: We have used an anterior wall of the MPA as a flap for LPA angioplasty in 42 patients with TOF and pulmonary stenosis (26 males and 16 females) since February 2007. During the same period, 116 patients underwent total repair of TOF with pulmonary stenosis...
December 2014: Journal of Thoracic and Cardiovascular Surgery
Sylvia S M Chen, Philip J Kilner
BACKGROUND: We sought to improve understanding of the diastolic prolongation of forward flow seen through a unilateral branch pulmonary artery (PA) stenosis. METHODS AND RESULTS: Of patients studied by cardiovascular magnetic resonance (CMR) for congenital heart disease, we reviewed right and left PA flow to find 10 cases with a diastolic prolongation of flow in a stenosed branch PA. They were aged 20 years (median, range = 14-40 years, 7 males). Seven had transposition of the great arteries corrected by arterial switch (TGA-AS) and 3 had repaired tetralogy of Fallot (rToF)...
October 9, 2013: International Journal of Cardiology
Karen G Ordovas, Stefano Muzzarelli, Michael D Hope, David M Naeger, Tom Karl, Gautham P Reddy, Edson Marchiori, Charles B Higgins
Tetralogy of Fallot (TOF) is one of the most common congenital heart diseases for which patients are referred for postoperative magnetic resonance (MR) imaging evaluation. The most common surgical procedures for TOF repair include infundibulectomy, transannular pulmonary artery patch repair, and right ventricle-pulmonary artery conduit placement. In the past few decades, surgery has proved successful, but most patients require repeat imaging throughout their lives. MR imaging is now frequently used for morphologic and functional evaluation after TOF repair...
July 2013: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Sameer Ahmed, Pamela Tecce Johnson, Elliot K Fishman, Stefan Loy Zimmerman
The population of adults with repaired tetralogy of Fallot (TOF) is growing, thanks to improvements in the surgical and medical management of this condition. Accordingly, late postrepair complications are important medical concerns in these individuals. Initial surgical repair of TOF typically occurs in infancy, consisting of patch repair of the ventricular septal defect (VSD) and relief of right ventricular outflow tract (RVOT) obstruction. Although patients may remain asymptomatic for several decades, the majority will have progressive pulmonic regurgitation that leads to right ventricular (RV) dilatation and functional deterioration...
July 2013: Radiographics: a Review Publication of the Radiological Society of North America, Inc
M A Palomero Rodríguez, M Gabaldón Rivilla, D Cabestrero Alonso, C Gonzalez Cibrián, C Abelleira Pardeiro, T Centella Hernánez, R Collado Gutierrez, M S Asuero de Lis, R Gómez González
Tetralogy of Fallot is a congenital heart disease that accounts for 11-13% of the congenital cardiomyopathies. Stenosis and hyperplasia of the pulmonary arteries occur in a high proportion of them as this disease causes a native stenosis of the pulmonary branch, which can be surgically repaired with a stent. The use of balloon expandable intravascular stents is an alternative technique to further surgery in patients with congenital heart diseases. However, despite the gradual increase in their use, the limited number of procedures, combined with the wide anatomical variability and different characteristics of these patients, even in expert hands, stent implants are associated with a not inconsiderable incidence of complications...
May 2014: Revista Española de Anestesiología y Reanimación
Nilesh Oswal, Georgi Christov, Shankar Sridharan, Sachin Khambadkone, Catherine Bull, Ian Sullivan
We determined the relationship between aortic arch anatomy in tetralogy of Fallot with pulmonary stenosis and chromosomal or genetic abnormality, by performing analysis of 257 consecutive patients undergoing surgical repair from January, 2003 to March, 2011. Chromosomal or genetic abnormality was identified in 49 of the 257 (19%) patients. These included trisomy 21 (n = 14); chromosome 22q11.2 deletion (n = 16); other chromosomal abnormalities (n = 9); CHARGE (n = 2); Pierre Robin (n = 2); and Kabuki, Alagille, Holt-Oram, Kaufman McKusick, Goldenhar, and PHACE (n = 1 each)...
June 2014: Cardiology in the Young
Shiraz A Maskatia, Joseph A Spinner, Shaine A Morris, Christopher J Petit, Rajesh Krishnamurthy, Arni C Nutting
Right ventricular (RV) volume overload secondary to pulmonary regurgitation is common in patients after initial repair of tetralogy of Fallot (TOF) and is associated with adverse long-term outcomes. The objective of the present study was to determine the effect of branch pulmonary artery stenosis on the RV volume in patients with repaired TOF. We reviewed 178 cardiac magnetic resonance imaging studies in patients with repaired TOF. We defined bilateral stenosis as a Nakata index of ≤200 mm(2)/m(2) and concordant branch pulmonary artery cross-sectional area, unilateral stenosis as 1 branch pulmonary artery cross-sectional area ≤100 mm(2)/m(2) and 1 branch pulmonary artery cross-sectional area >100 mm(2)/m(2), and restrictive physiology as prograde main pulmonary artery diastolic flow...
May 1, 2013: American Journal of Cardiology
Fedoua El Louali, Richard Azagoh-Kouadio, Issam Kammache, Virginie Fouilloux, Bernard Kreitmann, Alain Fraisse
A right ventricular outflow tract stent was implanted in a 1-month-old (3.5 kg) baby boy with tetralogy of Fallot and worsening cyanosis to relieve infundibular and pulmonary valve stenosis in the setting of well-developed pulmonary artery branches. This management allowed a symmetric and optimal growth of the pulmonary artery branches, with right and left pulmonary arteries measuring 7-mm (z-score, +1.3 SD) and 7.3-mm (z-score, +1.7 SD), respectively, 3 months after stent implantation. No signs of pulmonary overcirculation developed, and complete surgical repair was performed at the age of 6 months...
February 2013: Pediatric Cardiology
Rajesh Puranik, Victor Tsang, Philip Lurz, Vivek Muthurangu, Sophie Offen, Alessandra Frigiola, Wendy Norman, Fiona Walker, Philip Bonhoeffer, Andrew M Taylor
OBJECTIVE: Chronic pulmonary regurgitation (PR) has deleterious effects on right ventricular (RV) function in repaired tetralogy of Fallot (ToF). 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. METHODS: We retrospectively identified consecutive patients with PR who were referred for magnetic resonance imaging quantification of "free PR" detected on echocardiography between 2003 and 2008...
May 2012: Journal of Thoracic and Cardiovascular Surgery
Matthew A Harris, Kevin K Whitehead, Matthew J Gillespie, Timothy Y Liu, Michael T Cosulich, David C Shin, Elizabeth Goldmuntz, Paul M Weinberg, Mark A Fogel
OBJECTIVES: We sought to investigate whether differential branch pulmonary artery (BPA) regurgitation correlates with differences in BPA anatomy and physiology. BACKGROUND: Patients with repaired conotruncal anomalies such as Tetralogy of Fallot frequently have residual BPA stenosis or BPA size differences. Previous reports have demonstrated an increased left pulmonary artery (LPA) regurgitant fraction (RF) in these patients. METHODS: We retrospectively reviewed 76 consecutive cardiac magnetic resonance (CMR) studies for BPA size and phase-contrast magnetic resonance data, including 13 consecutive patients who underwent both CMR and catheterization...
May 2011: JACC. Cardiovascular Imaging
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