Accuracy of a New Echocardiographic Index to Predict Need for Trans-annular Patch in Tetralogy of Fallot

Kasturi, Sowmya; Balaji, Seshadri; Sudhakar, Abish; Sunil, Gopalraj Sumangala; Kottayil, Brijesh P; Bayya, Praveen Reddy; Kumar, Raman Krishna

doi:10.1007/s00246-018-1973-x

Cited by 13 publications

(15 citation statements)

References 19 publications

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“…In this cohort, 130 (45.4%) patients underwent repair without TAP augmentation, which is similar to or even better than the results reported by other centers (18)(19)(20). However, it is thought that the placement of the TAP often results in relatively delayed postoperative recovery after surgical repair (17).…”

Section: Treatment Management and Early Outcomes Of Tof Patientssupporting

confidence: 83%

Pulmonary Vein Index Is Associated With Early Prognosis of Surgical Treatment for Tetralogy of Fallot

et al. 2021

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Objectives: To evaluate the predictive value of the pulmonary vein index (PVI) in the early prognosis of patients who received total tetralogy of Fallot (TOF) repair.Methods: We retrospectively reviewed 286 patients who underwent TOF repair in our institution between July 2013 and May 2020. The PVI, McGoon ratio, and Nakata index were measured and calculated. Logistic regression, linear stepwise regression, receiver operating characteristic (ROC) curve analysis, and Cox proportional hazards modeling were performed to evaluate the predictive value of PVI in the early prognosis after TOF repair surgery.Results: The median age and body weight were 1.23 (0.22–15.02) years and 9.00 (3.00–44.00) kg, respectively. There were five early deaths. The areas under the ROC curve for death were 0.89, 0.79, and 0.88 for the McGoon ratio, Nakata index, and PVI, respectively. A lower PVI better predicted prolonged postoperative hospital stay, cardiac intensive care unit stay, and ventilator time (Hazard Ratio, HR [95% Confidence intervals, CI]: 1.003 [1.002–1.004], p < 0.001; 1.002 [1.001–1.004], p < 0.001; 1.002 [1.001–1.003], p < 0.001, respectively) and was a significant risk factor for high 24 h max Vasoactive inotropic score (Crude Odds Ratio [OR] [95% CI]: −0.015 [−0.022, −0.007], p < 0.001), serous effusion (Crude OR [95% CI]: 0.996 [0.992–0.999], p = 0.020), delayed sternal closure (Crude OR [95% CI]: 0.983 [0.971–0.996], p = 0.010), and the need for peritoneal dialysis (Crude OR [95% CI]: 0.988 [0.980–0.996], p = 0.005). The area under the ROC curve of PVI for delayed postoperative recovery was 0.722 (p < 0.001), and the estimated cutoff point was 300.3 mm2/m2.Conclusion: PVI is a good predictor of early prognosis for surgical treatment of TOF patients.

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Section: Treatment Management and Early Outcomes Of Tof Patientssupporting

confidence: 83%

Pulmonary Vein Index Is Associated With Early Prognosis of Surgical Treatment for Tetralogy of Fallot

et al. 2021

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“…In some recent studies, alternative measurement methods have been proposed that can be used instead of the pulmonary annulus Z-score. Kasturi et al suggested the use of "pulmonary annulus index," calculated indirectly by using the pulmonary and aortic annulus diameters and which expresses the proportion of observed and expected pulmonary annulus diameters along with the pulmonary annulus Z-scores (15) . Choi et al stated that the ratio of pulmonary-to aortic annulus diameter and descending aorta diameter can be used for this purpose (16) .…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Valve-Sparing Surgery in Tetralogy of Fallot: Early Results of Pulmonary Flow Hemodynamics

Yildirim

Balaban

2020

Kosuyolu Heart Journal

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Introduction: Tetralogy of Fallot is the most common form of cyanotic congenital heart disease. We aimed to share our experience of pulmonary annulus preserving surgery as the current and increasingly preferred treatment option in this study. Patients and Methods:In this study, the data of 30 pediatric patients who underwent corrective repair by preserving the pulmonary valve annulus were evaluated retrospectively. Demographic data, angiographic, and echocardiographic findings before and after surgery were recorded. Results:In our study, 20 (66.7%) patients were male, 10 (33.3%) were female; median age of the patients was 29 months. In the preoperative evaluation, 16 patients had a pulmonary valve with two leaflets (53.3%), and 14 patients had three leaflets (46.7%). McGoon indexes calculated as mean 1.82 ± 0.23 by echocardiography and 2 ± 0.29 by angiography. Pulmonary valve annulus Z-scores were determined as mean -1.8 ± 1.1 echocardiographically and -0.9 ± 1.2 angiographically. Mean right ventricle systolic pressures measured in echocardiographic examination at 1 st , 7 th , and 14 th days after surgery were 42.3 ± 6.5, 38.7 ± 4.9, and 35.8 ± 4.9 mmHg, respectively, and decreasing values were significant statistically. Pulmonary valve pressure gradients measured at postoperative 1 st , 7 th , and 14 th days and found as mean 27.2 ± 5.6, 25.5 ± 6.2, and 24.4 ± 6.2 mmHg, respectively; this decrease was also statistically significant. There was no mortality or significant morbidity during the mean 7.97 ± 3.39 months follow-up period. Conclusion:Preservation of pulmonary valve during surgery is an effective treatment option in the treatment of tetralogy of Fallot in terms of reducing early and late complications and should become a more prevalent technique.

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“…In this study, the Z score calculations of the pulmonary valve ring and active artery were based on the literature published in 2017 17 . GA ratio refers to the ratio between pulmonary and aortic annulus, whereas PAI 18 refers to the concept that in a normal heart, the conical diaphragm divides the arterial trunk (common outlet artery) into two equal left and right ventricular outflow passages. Correspondingly, the size of the pulmonary artery and aortic annulus is almost equal.…”

Section: Methodsmentioning

confidence: 99%

“…In 2016, Choi et al 17 proposed that the ratio between the pulmonary annulus and aortic annulus should be used to predict whether TAP is needed in TOF correction. In 2019, Kasturi et al 18 proposed that TAP could be predicted from the pulmonary annulus index (PAI). In 2020, Zhao et al 19 used phylum‐to‐aortic valve annulus cross‐sectional area ratio (PAAI) to predict TAP.…”

Section: Introductionmentioning

confidence: 99%

Value of pulmonary annulus index in predicting transannular patch in tetralogy of Fallot repair

Lyu

Jin

Yang

2021

Journal of Cardiac Surgery

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Objective: It is very important to accurately assess the transannular patch (TAP) in the surgical treatment of tetralogy of Fallot (TOF). The pulmonary annulus index (PAI; the actual pulmonary annulus diameter divided by the expected pulmonary annulus diameter), GA ratio (the ratio of pulmonary annulus and aortic annulus), PAAI (the ratio of pulmonary annulus cross-section and aortic annulus crosssection), and pulmonary annulus Z score (PA Z score) were compared. This study aimed to analyze and explore the application value of PAI in predicting the need for TAP in children undergoing TOF repair.Methods: In total, 130 patients who were diagnosed with TOF and underwent TOF repair in Beijing Anzhen Hospital affiliated to Capital Medical University from December 2018 to December 2019 were retrospectively studied. In total, 112 cases were included in this study and 18 cases were excluded, of which 16 cases were aged above 18 years and 2 cases suffered from Down syndrome. They were divided into TAP group and no TAP group; the values of the pulmonary annulus and aortic annulus were measured. GA ratio, PAI, PAAI, the pulmonary annulus Z score, and main pulmonary artery (MPA) Z score were calculated to perform statistical analysis.Results: A total of 112 patients were included in the study, aged 4-177 months, with an average of 22.87 ± 30.21 months; 66 males and 46 females; weighing 5.3-29 kg, with an average of 9.94 ± 4.08 kg; three cases died, one case died of sepsis caused by pulmonary infection, one case died of low cardiac output syndrome, and one case died of multiple organ failure. In total, 62 cases (55.8%) did not undergo TAP and 50 cases (44.2%) underwent TAP. The pulmonary annulus Z score, main pulmonary artery Z score, and PAI in the TAP group were smaller than those in the no TAP group (p < .05). Receiver operating curve (ROC) analysis showed that when the cut-off value of pulmonary annulus was −1.98, the area under the curve (AUC) was 0.88, the sensitivity was 80%, and the specificity was 71%; when the cutoff value of PAI was 0.53, AUC was 0.85, the sensitivity was 75%, and the specificity was 80%; when the cut-off value of GA ratio was 0.55, AUC was 0.85, the sensitivity was 76%, and the specificity was 80%. The area under the PAAI curve was 0.85, the sensitivity was 76%, and the specificity was 79%. When the pulmonary valve Z score, PAI, GA ratio, PAAI, and MPA Z score were all greater than the dividing value, TAP was avoided in more than 90% of children with TOF. When the pulmonary valve Z score, PAI, GA ratio, PAAI, and the main pulmonary artery Z score were all below the dividing value, more than 90% of children with TOF needed TAP. Conclusion:The predictive effect of PAI as a simple and effective predictor of TAP in TOF radical operation is the same as that of pulmonary annulus Z score, and combining it with the main pulmonary artery Z score was the most accurate method of prediction.main pulmonary artery Z score, pulmonary annulus index, pulmonary annulus Z score, tetralogy of Fallot, transannular pat...

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Accuracy of a New Echocardiographic Index to Predict Need for Trans-annular Patch in Tetralogy of Fallot

Cited by 13 publications

References 19 publications

Pulmonary Vein Index Is Associated With Early Prognosis of Surgical Treatment for Tetralogy of Fallot

Pulmonary Vein Index Is Associated With Early Prognosis of Surgical Treatment for Tetralogy of Fallot

Pulmonary Valve-Sparing Surgery in Tetralogy of Fallot: Early Results of Pulmonary Flow Hemodynamics

Value of pulmonary annulus index in predicting transannular patch in tetralogy of Fallot repair

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