Clinical performance of the native pulmonary valve in the systemic circulation.

BACKGROUND AND AIM OF THE STUDY: In a number of corrective and palliative procedures the autologous pulmonary valve is used as the systemic semilunar valve. This study reviews the surgical results and function of the native pulmonary valve in the systemic position after various surgical procedures.

METHODS

Between January 1994 and December 1997, the autologous pulmonary valve was transferred functionally or anatomically into the systemic circulation in 89 patients. Follow up echocardiograms and cardiac angiograms were reviewed for 51 neonates with transposition of the great arteries after an arterial switch operation (ASO), in 21 patients after first-stage palliation of hypoplastic left heart syndrome (HLHS), in eight children and adults with pulmonary autograft aortic valve replacement (Ross procedure), and in nine patients with a pulmonary artery-to-aortic anastomosis (Damus-Kaye-Stansel (DKS) procedure) in complex heart defects with outflow obstruction.

RESULTS

Nine patients (five with HLHS) died; thus, overall mortality rate was 10.2%. There was no evidence of valve-related mortality. Trivial insufficiency following ASO was noted in 11 patients, with no progression of incompetence over time. None of the HLHS patients had pulmonary insufficiency preoperatively, but all showed mild regurgitation on postoperative echocardiography. There was a moderate increase in insufficiency which was attenuated after an early second-stage palliation. Three of nine patients undergoing a DKS anastomosis demonstrated a hemodynamically insignificant insufficiency. Modification of the surgical technique avoided postoperative regurgitation. Four of seven patients having a Ross procedure showed trivial but non-progressive neoaortic regurgitation.

CONCLUSIONS

Based on this experience, the autologous pulmonary valve performs adequately at intermediate term follow up. Postoperatively, trivial regurgitation was a frequent finding but was hemodynamically insignificant. Progression or late development of insufficiency as well as stenosis were rare problems.