Abstract:patients present in need of reoperative surgical reconstruction of the right ventricular outflow tract. The predominant physiologic lesion is pulmonary insufficiency, but there may also be varying degrees of obstruction of the right ventricular outflow tract. In the past, it has been felt that patients tolerate pulmonary insufficiency reasonably well. In some patients, however, the long-term effects of pulmonary insufficiency and subsequent right ventricular dilation and dysfunction are associated with poor ex… Show more
“…We have described previously the creation of the monocusp patch. 30 Once we had decided on its size, the patch was tailored according to the expected size of the pulmonary trunk and the subpulmonary outflow tract. The patch was then folded with the smooth side of the patch facing the pulmonary flow.…”
Section: Methodsmentioning
confidence: 99%
“…The second strategy, therefore, is to protect as far as possible the function of the native pulmonary valvar leaflets, or to create a new valve in pulmonary position when the transjunctional repair is inevitable. 13 Different methods have been used to create a new valve, including insertion of a valved homograft patch, 3,7 monocusp patches constructed from xenografts, homografts, fascia lata, autologous pulmonary artery, or pericardium, 5,[14][15][16][17][18][19][20][21][22][23][24][25][26][27] devices made of Gore-Tex, 28 or polytetrafluorethylene, 5,29 creation of a bifoliate polytetrafluoroethylene prosthesis, 30,31 or reconstruction of an autologous and competent trifoliate valve using native tissues. 26 We have recently described our own technique of creating an autologous pericardial monocusp patch containing 2 glutaraldehyde-treated pericardial patches.…”
Based on our experience, we suggest that the current strategy of repair of tetralogy of Fallot in older children and adults should be based on minimizing the insertion of transjunctional patches, this being indicated only in those with very small ventriculo-pulmonary junctions. If such a patch is necessary, then steps should be taken to preserve the function of the pulmonary valve.
“…We have described previously the creation of the monocusp patch. 30 Once we had decided on its size, the patch was tailored according to the expected size of the pulmonary trunk and the subpulmonary outflow tract. The patch was then folded with the smooth side of the patch facing the pulmonary flow.…”
Section: Methodsmentioning
confidence: 99%
“…The second strategy, therefore, is to protect as far as possible the function of the native pulmonary valvar leaflets, or to create a new valve in pulmonary position when the transjunctional repair is inevitable. 13 Different methods have been used to create a new valve, including insertion of a valved homograft patch, 3,7 monocusp patches constructed from xenografts, homografts, fascia lata, autologous pulmonary artery, or pericardium, 5,[14][15][16][17][18][19][20][21][22][23][24][25][26][27] devices made of Gore-Tex, 28 or polytetrafluorethylene, 5,29 creation of a bifoliate polytetrafluoroethylene prosthesis, 30,31 or reconstruction of an autologous and competent trifoliate valve using native tissues. 26 We have recently described our own technique of creating an autologous pericardial monocusp patch containing 2 glutaraldehyde-treated pericardial patches.…”
Based on our experience, we suggest that the current strategy of repair of tetralogy of Fallot in older children and adults should be based on minimizing the insertion of transjunctional patches, this being indicated only in those with very small ventriculo-pulmonary junctions. If such a patch is necessary, then steps should be taken to preserve the function of the pulmonary valve.
“…5). Common operations include late insertion of a pulmonary valve for patients with tetralogy of Fallot and pulmonary insufficiency, often using a novel bicuspid polytetrafluoroethylene pulmonary valve that was developed by our surgical team, and has been inserted in over 90 patients, 15 , 16 as well as revision of the Fontan circulation, with conversion of a prior classical Fontan circuit to the total cavopulmonary connection accompanied by a Maze procedure, 4 and a variety of other valvar repairs and replacements, and replacements of conduits.Figure 5Discharge mortality following cardiac surgery from the database of the Society of Thoracic Surgeons for the years 2002 to 2005 inclusive. It is notable that mortality is highest in neonates, then decreases in infants, decreases more in older children, but then increases again in the population of adults with congenital heart disease.…”
Section: Challenges In Establishing a Community Programme For Adultsmentioning
confidence: 99%
“…5). Common operations include late insertion of a pulmonary valve for patients with tetralogy of Fallot and pulmonary insufficiency, often using a novel bicuspid polytetrafluoroethylene pulmonary valve that was developed by our surgical team, and has been inserted in over 90 patients, 15,16 as well as revision of the Fontan circulation, with conversion of a prior classical Fontan circuit to the total cavopulmonary connection accompanied by a Maze procedure, 4 and a variety of other valvar repairs and replacements, and replacements of conduits. Future efforts will focus on expanding the inpatient and outpatient infrastructure, centralization of inpatient services, expanding the role of care coordinators, and emphasizing patient and family education, continued follow-up, activity levels, and planning of pregnancies.…”
Patients with congenital cardiac disease require lifelong medical care. Current challenges that face practitioners who care for adults with congenital heart disease include identifying the best location for procedures, which could be a children's hospital, an adult hospital, or a tertiary care facility; providing appropriate antenatal management of pregnant women with congenitally malformed hearts, and continuing this care in the peripartum period; and securing the infrastructure and expertise of the non-cardiac subspecialties, such as nephrology, hepatology, pulmonary medicine, and haematology. The objectives of this review are to outline the common problems that confront this population of patients and the medical community, to identify challenges encountered in establishing a programme for care of adults with congenitally malformed hearts, and to review the spectrum of disease and operations that have been identified in a high volume tertiary care centre for adult patients with congenital cardiac disease. Three chosen examples of the fundamental problems facing the practitioner and patient in the United States of America in 2007 are the neglected patient with congenital cardiac disease, weak infrastructure for adults with congenital cardiac disease, and family planning and management of pregnancy for patients with congenital cardiac disease. Patients with adult congenital cardiac disease often do not receive appropriate surveillance. Three fundamental reasons for this problem are, first, that most adults with congenitally malformed hearts have been lost to follow-up by specialists, and are either receiving community care or no care at all. Second, patients and their families have not been educated about their malformed hearts, what to expect, and how to protect their interests most effectively. Third, adult physicians have not been educated about the complexity of the adult with a congenitally malformed heart. This combination can be fatal for adults with complications related to their congenitally malformed heart, or its prior treatment. Two solutions would improve surveillance and care for the next generation of patients coming out of the care of paediatric cardiologists. The first would be to educate patients and their families during childhood and adolescence. They would learn the names of the diagnoses and treatments, the problems they need to anticipate and avoid, the importance of expert surveillance, career and family planning information, and appropriate self-management. The second solution would be to encourage an orderly transfer of patients from paediatric to adult practice, usually at about 18 years of age, and at the time of graduation from high school. Clinics for adults with congenital cardiac disease depend upon multidisciplinary collaboration with specialties in areas such as congenital cardiac imaging, diagnostic and interventional catheterization, congenital cardiac surgery and anaesthesia, heart failure, transplantation, electrophysiology, reproductive and high risk pregnancy services, gen...
“…Many patients eventually require replacement of the pulmonary valve due to chronic pulmonary insufficiency. The use of Gore-Tex bifoliate pulmonary valves may have advantages over standard pulmonary homografts or porcine valves when used as replacements 13 , 14 . In addition, the transcatheter delivery of stented bovine pulmonary valves is now possible, although their long-term results are still being evaluated.…”
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