The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 2 , Pages 382-389 , August 2009

Relief of branch pulmonary artery stenosis reduces pulmonary valve insufficiency in a swine model

  • Christopher J. Petit, MD

      Affiliations

    • Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pa
    • Corresponding Author InformationAddress for reprints: Christopher J. Petit, MD, Texas Children's Hospital, Section of Cardiology, 6621 Fannin St, MC–19345 C, Houston, TX 77030.
    • ,
  • Matthew J. Gillespie, MD

      Affiliations

    • Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pa
    • ,
  • Matthew A. Harris, MD

      Affiliations

    • Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pa
    • ,
  • Travis L. Seymour, BA

      Affiliations

    • Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pa
    • ,
  • Timothy Y. Liu, BA

      Affiliations

    • Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pa
    • ,
  • Azeem Khan, MD

      Affiliations

    • Division of Cardiothoracic Surgery, Department of Surgery, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pa
    • ,
  • J. William Gaynor, MD

      Affiliations

    • Division of Cardiothoracic Surgery, Department of Surgery, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pa
    • ,
  • Jonathan J. Rome, MD

      Affiliations

    • Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pa

Received 20 October 2008 ,Revised 12 January 2009 ,Accepted 16 February 2009.

References 

  1. Gatzoulis MA, Balaji S, Webber SA, Siu SC, Hokanson JS, Poile C, et al. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. Lancet. 2000;356:975–981
  2. Harrison DA, Harris L, Siu SC, MacLoghlin CJ, Connelly MS, Webb GD, et al. Sustained ventricular tachycardia in adult patients late after repair of tetralogy of Fallot. J Am Coll Cardiol. 1997;30:1368–1373
  3. Rowe SA, Zahka KG, Manolio TA, Horneffer PJ, Kidd L. Lung function and pulmonary regurgitation limit exercise capacity in postoperative tetralogy of Fallot. J Am Coll Cardiol. 1991;17:461–466
  4. Ghai A, Silversides C, Harris L, Webb GD, Siu SC, Therrien J. Left ventricular dysfunction is a risk factor for sudden cardiac death in adults late after repair of tetralogy of Fallot. J Am Coll Cardiol. 2002;40:1675–1680
  5. Wessel HU, Cunningham WJ, Paul MH, Bastanier CK, Muster AJ, Idriss FS. Exercise performance in tetralogy of Fallot after intracardiac repair. J Thorac Cardiovasc Surg. 1980;80:582–593
  6. Davlouros PA, Karatza AA, Gatzoulis MA, Shore DF. Timing and type of surgery for severe pulmonary regurgitation after repair of tetralogy of Fallot. Int J Cardiol. 2004;97(Suppl 1):91–101
  7. Therrien J, Provost Y, Merchant N, Williams W, Colman J, Webb G. Optimal timing for pulmonary valve replacement in adults after tetralogy of Fallot repair. Am J Cardiol. 2005;95:779–782
  8. Therrien J, Siu SC, McLaughlin PR, Liu PP, Williams WG, Webb GD. Pulmonary valve replacement in adults late after repair of tetralogy of Fallot: are we operating too late?. J Am Coll Cardiol. 2000;36:1670–1675
  9. Bove EL, Kavey RE, Byrum CJ, Sondheimer HM, Blackman MS, Thomas FD. Improved right ventricular function following late pulmonary valve replacement for residual pulmonary insufficiency or stenosis. J Thorac Cardiovasc Surg. 1985;90:50–55
  10. van Huysduynen BH, van SA, Swenne CA, Maan AC, van Eck HJ, Schalij MJ, et al. Reduction of QRS duration after pulmonary valve replacement in adult Fallot patients is related to reduction of right ventricular volume. Eur Heart J. 2005;26:928–932
  11. Khambadkone S, Coats L, Taylor A, Boudjemline Y, Derrick G, Tsang V, et al. Percutaneous pulmonary valve implantation in humans: results in 59 consecutive patients. Circulation. 2005;112:1189–1197
  12. Uretzky G, Puga FJ, Danielson GK, Hagler DJ, McGoon DC. Reoperation after correction of tetralogy of Fallot. Circulation. 1982;66(2 Pt 2):I202–I208
  13. McElhinney DB, Parry AJ, Reddy VM, Hanley FL, Stanger P. Left pulmonary artery kinking caused by outflow tract dilatation after transannular patch repair of tetralogy of Fallot. Ann Thorac Surg. 1998;65:1120–1126
  14. Sharma SN, Sharma S, Shrivastava S, Rajani M, Tandon R. Pulmonary arterial anatomy in tetralogy of Fallot. Int J Cardiol. 1989;25:33–37
  15. Rhodes J, Dave A, Pulling MC, Geggel RL, Marx GR, Fulton DR, et al. Effect of pulmonary artery stenoses on the cardiopulmonary response to exercise following repair of tetralogy of Fallot. Am J Cardiol. 1998;81:1217–1219
  16. Ilbawi MN, Idriss FS, DeLeon SY, Muster AJ, Gidding SS, Berry TE, et al. Factors that exaggerate the deleterious effects of pulmonary insufficiency on the right ventricle after tetralogy repair. Surgical implications. J Thorac Cardiovasc Surg. 1987;93:36–44
  17. Hawk C, Leary S, Morris T. Formulary for Laboratory Animals. 3rd edition. Durham, NC: Blackwell Publishing; 2005;
  18. Bouzas B, Kilner PJ, Gatzoulis MA. Pulmonary regurgitation: not a benign lesion. Eur Heart J. 2005;26:433–439
  19. Wu MT, Huang YL, Hsieh KS, Huang JT, Peng NJ, Pan JY, et al. Influence of pulmonary regurgitation inequality on differential perfusion of the lungs in tetralogy of Fallot after repair: a phase-contrast magnetic resonance imaging and perfusion scintigraphy study. J Am Coll Cardiol. 2007;49:1880–1886
  20. Hirsch JC, Mosca RS, Bove EL. Complete repair of tetralogy of Fallot in the neonate: results in the modern era. Ann Surg. 2000;232:508–514
  21. Dowdle SC, Human DG, Mann MD. Pulmonary ventilation and perfusion abnormalities and ventilation perfusion imbalance in children with pulmonary atresia or extreme tetralogy of Fallot. J Nucl Med. 1990;31:1276–1279
  22. Bouzas B, Kilner PJ, Gatzoulis MA. Pulmonary regurgitation: not a benign lesion. Eur Heart J. 2005;26:433–439
  23. de Ruijter FT, Weenink I, Hitchcock FJ, Meijboom EJ, Bennink GB. Right ventricular dysfunction and pulmonary valve replacement after correction of tetralogy of Fallot. Ann Thorac Surg. 2002;73:1794–1800
  24. Chaturvedi RR, Kilner PJ, White PA, Bishop A, Szwarc R, Redington AN. Increased airway pressure and simulated branch pulmonary artery stenosis increase pulmonary regurgitation after repair of tetralogy of Fallot. Real-time analysis with a conductance catheter technique. Circulation. 1997;95:643–649
  25. Higgins CB, Sakuma H. Heart disease: functional evaluation with MR imaging. Radiology. 1996;199:307–315
  26. Kang IS, Redington AN, Benson LN, Macgowan C, Valsangiacomo ER, Roman K, et al. Differential regurgitation in branch pulmonary arteries after repair of tetralogy of Fallot: a phase-contrast cine magnetic resonance study. Circulation. 2003;107:2938–2943
  27. Sorrell VL, Altbach MI, Kudithipudi V, Squire SW, Goldberg SJ, Klewer SE. Cardiac MRI is an important complementary tool to Doppler echocardiography in the management of patients with pulmonary regurgitation. Echocardiography. 2007;24:316–328
  28. O'Laughlin MP, Slack MC, Grifka RG, Perry SB, Lock JE, Mullins CE. Implantation and intermediate-term follow-up of stents in congenital heart disease. Circulation. 1993;88:605–614
  29. Shaffer KM, Mullins CE, Grifka RG, O'Laughlin MP, McMahon W, Ing FF, et al. Intravascular stents in congenital heart disease: short- and long-term results from a large single-center experience. J Am Coll Cardiol. 1998;31:661–667
  30. Spadoni I, Giusti S, Bertolaccini P, Maneschi A, Kraft G, Carminati M. Long-term follow-up of stents implanted to relieve peripheral pulmonary arterial stenosis: hemodynamic findings and results of lung perfusion scanning. Cardiol Young. 1999;9:585–591
  31. Stanfill R, Nykanen DG, Osorio S, Whalen R, Burke RP, Zahn EM. Stent implantation is effective treatment of vascular stenosis in young infants with congenital heart disease: acute implantation and long-term follow-up results. Catheter Cardiovasc Interv. 2008;71:831–841

 Disclosures: The authors have no conflicts of interest to disclose.

 This study was funded by a Career Development Grant awarded to Dr Christopher Petit from The Children's Hospital of Philadelphia.

PII: S0022-5223(09)00357-2

doi: 10.1016/j.jtcvs.2009.02.030

The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 2 , Pages 382-389 , August 2009

Article Tools

* Image Usage & Resolution