Surgical repair of tetralogy of Fallot using autologous right atrial appendages: short- to mid-term results.
OBJECTIVES
The prevention of pulmonary insufficiency (PI) is a crucial part of the tetralogy of Fallot repair. Many techniques have been introduced to construct valves from different materials for the right ventricular outflow tract, including the most commonly constructed monocusp valves. We are introducing a new bicuspid valve made intraoperatively using the autologous right atrial appendage (RAA) to prevent PI in these patients.


METHODS
The RAA valve was constructed and used in 21 patients with tetralogy of Fallot. The effective preservation of the native valve was impossible in all patients because of either a severe valve deformity or a small annulus. The RAA valve was created after ventricular septal defect closure and right ventricular outflow tract myectomy and was covered with a bovine transannular pericardial patch. The perioperative data were evaluated, and the echocardiography results were assessed immediately after operations and in follow-up with a median of 10.5 months. The data were retrospectively compared with 10 other patients with similar demographic data but with only transannular patches.


RESULTS
The mean age of the patients was 13.3 months. No mortality or related morbidity occurred after repair using the RAA valve. The PI severity early after the operation was trivial or no PI in 18 patients, and mild PI was observed in 3 patients, which progressed to moderate PI in one of them in the mean 12-month follow-up period. Fifteen patients had mild or no pulmonary stenosis, while moderate pulmonary stenosis was observed in 6 others. Compared with the other 10 patients with only transannular patches, the RAA valve patients had prolonged operative and clamping times, but no difference in postoperative course and shorter hospital stays. The degree of PI was, of course, significantly less in the RAA valve patients, but pulmonary stenosis was the same.


CONCLUSIONS
The RAA valve construction is a safe and effective technique to prevent PI after the tetralogy of Fallot repair, at least in terms of short- and mid-term results. A longer follow-up period is needed to confirm if this new valve can eliminate or significantly delay the need for pulmonary valve replacement in these patients.
['Amirghofran|Ahmadali|A|', 'Edraki|Fatemeh|F|', 'Edraki|Mohammadreza|M|', 'Ajami|Gholamhossein|G|', 'Amoozgar|Hamid|H|', 'Mohammadi|Hamid|H|', 'Emaminia|Abbas|A|', 'Ghasemzadeh|Bahram|B|', 'Borzuee|Mohammad|M|', 'Peiravian|Farah|F|', 'Kheirandish|Zahra|Z|', 'Mehdizadegan|Nima|N|', 'Sabri|Mohammadreza|M|', 'Cheriki|Sirus|S|', 'Arabi|Hamid|H|']
D000818:Animals D020517:Atrial Appendage D002417:Cattle D006801:Humans D007223:Infant D011664:Pulmonary Valve D011665:Pulmonary Valve Insufficiency D012189:Retrospective Studies D013771:Tetralogy of Fallot D016896:Treatment Outcome
Tetralogy of Fallot Right atrial appendage Pulmonary insufficiency Transannular patch