Abstract
Objective
Surgical experiences of the reoperative double ventricular outflow tract reconstruction long after the successful repair of conotruncal anomalies were reviewed.
Methods
Ten adult patients with conotruncal anomalies (6 females, 22.9 ± 5.5 years old) underwent the reoperative double ventricular outflow tract reconstruction. Primary diagnosis was pulmonary atresia with ventricular septal defect in 6 patients, truncus arteriosus in 3, and double-outlet right ventricle in 1. The indication for the left ventricular outflow tract reconstruction was the left ventricular dilatation and dysfunction derived from moderate or greater systemic semilunar valve insufficiency. The indication for the right ventricular outflow tract reconstruction was severe pulmonary insufficiency in all patients, and concomitant right ventricular outflow tract obstruction in 7.
Results
The systemic semilunar valve replacement was performed in all patients. The right ventricular outflow tract patching was performed in 4 patients, and the revision of extra-cardiac conduit in 6. Within a mean follow-up of 9.0 ± 7.0 years, there was no mortality. The left ventricular end-diastolic volume index improved from 147 ± 37 to 108 ± 19 ml/m2 (p = 0.005), and the peak pressure gradient across right ventricular outflow tract improved from 43 ± 17 mmHg to 9 ± 2 at 1 year after (p = 0.02). The plasma brain natriuretic peptide level improved from 83 ± 57 to 34 ± 32 pg/ml (p = 0.03).
Conclusions
Reoperative double ventricular outflow tract reconstruction long after the repair of conotruncal anomalies was safely performed, and provided the ventricular reverse remodeling and improvement of serum BNP level.
Similar content being viewed by others
References
Kaza AK, Lim HG, Dibardino DJ, Bautista-Hernandez V, Robinson J, Allan C, et al. Long-term results of right ventricular outflow tract reconstruction in neonatal cardiac surgery: options and outcomes. J Thorac Cardiovasc Surg. 2009;138:911–6.
Berdat PA, Immer F, Pfammatter JP, Carrel T. Reoperations in adults with congenital heart disease: analysis of early outcome. Int J Cardiol. 2004;93:239–45.
Giamberti A, Chessa M, Abella R, Butera G, Carlucci C, Nuri H, et al. Morbidity and mortality risk factors in adults with congenital heart disease undergoing cardiac reoperations. Ann Thorac Surg. 2009;88:1284–90.
Niwa K. Aortic root dilatation in tetralogy of Fallot long-term after repair-histology of the aorta in tetralogy of Fallot: evidence of intrinsic aortopathy. Int J Cardiol. 2005;103:117–9.
Dearani JA, Burkhart HM, Stulak JM, Sundt TM, Schaff HV. Management of the aortic root in adult patients with conotruncal anomalies. Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann. 2009;12:122–9.
Mongeon FP, Gurvitz MZ, Broberg CS, Aboulhosn J, Opotowsky AR, Kay JD, Alliance for Adult Research in Congenital Cardiology (AARCC), et al. Aortic root dilatation in adults with surgically repaired tetralogy of fallot: a multicenter cross-sectional study. Circulation. 2013;127:172–9.
Holst KA, Dearani JA, Burkhart HM, Connolly HM, Warnes CA, Li Z, et al. Reoperative multivalve surgery in adult congenital heart disease. Ann Thorac Surg. 2013;95:1383–9.
François K, Zaqout M, Bové T, Vandekerckhove K, De Groote K, Panzer J, et al. The fate of the aortic root after early repair of tetralogy of Fallot. Eur J Cardiothorac Surg. 2010;37:1254–8.
Aru GM, Juraszek A, Moskowitz I, Van Praagh R. Tetralogy of Fallot with congenital aortic valvar stenosis: the tetralogy-truncus interrelationship. Pediatr Cardiol. 2006;27:354–9.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Kusajima, K., Hoashi, T., Kagisaki, K. et al. Reoperative double ventricular outflow tract reconstruction in grown-up congenital heart disease patients with conotruncal anomalies. Gen Thorac Cardiovasc Surg 63, 595–600 (2015). https://doi.org/10.1007/s11748-015-0581-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11748-015-0581-4