The Right and Left Ventricular Function After Surgical Correction with Pericardia! Monocusp in Tetralogy of Fallot: Mid-Term Result

WORAKAN PROMPHAN, M.D.*, SUKASOM ATTANAWANIT,M.D.**, SUTHEP WANITKUN,M.D.*, PONGSAK KHOWSATHIT, M.D.*

Affiliation : * Division of Pediatric Cardiology, Department of Pediatrics, ** Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.

AbstractBackground : Surgical repair of tetralogy of Fallot (TOF) with reconstruction of the right ventricular (RV) outflow tract invariably results in pulmonary regurgitation (PR). Chronic PR has been associated with RV dysfunction and ventricular arrhythmia. Pericardia! monocusp has recently been used at Ramathibodi Hospital to preserve pulmonary valve function.
Objectives : First, to study the competency of the pericardia! monocusp, one-year after correction. Second, to assess the right and left ventricular (LV) functions after surgery. Third, to assess correlation between severity of PR and the characters of electrocardiography (ECG) and chest X-ray (CXR) after correction.
Method : A cross-sectional study was conducted in patients who, had undergone total correction for TOF at least one year ago. The past medical history was retrospectively reviewed from the medical records. The patients who underwent surgical correction with and without pericardia! monocusp were recruited into group I and group II, respectively. The clinical symptoms, QRS duration from ECG, and cardia-thoracic (CT) ratio from CXR were analyzed. From the echocardiographic standpoint, the LV systolic function was determined by LV fractional shortening (L VFS), whereas the RV systolic function was determined by the tricuspid annular plane systolic excursion (TAPSE). Restrictive physiology of the RV was determined by presence of antegrade flow across the pulmonary valve during diastole.
Results : Sixty four patients were enrolled in the study, 7 in group I and 57 in group II. The median follow-up time after the surgery was 6.5 years, which was 3 years in group I and 7 years in group II (pO.O 1) . The median of the L VFS was 32.4 per cent, and of the T APSE was 10.5 mm. There was no restrictive physiology of the RV in all patients. There were no significant correlations between symptoms, CT-ratio, QRS duration and the severity of PR.
Conclusions : The pericardia! monocusp could neither reduce severity of PR nor improve right and left ventricular functions after 3 years follow-up post-operatively. However, the right and left ventricular performances in mid-term period remained insignificantly changed and severity of PR could not be predicted from symptoms and simple laboratory investigations.

Keywords : Tetralogy of Fallot, Total Correction, Pulmonary Regurgitation

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