Secondary repair of incompetent pulmonary valves.

BACKGROUND

Secondary repair of the pulmonary valve after right ventricular outflow tract (RVOT) reconstruction is infrequently reported. This article describes possible techniques of secondary pulmonary valve repair and reports follow-up results.

METHODS

Secondary pulmonary valve repairs in 7 patients (5 children and 2 adults) in our institution were reviewed. All patients presented with a severe pulmonary valve regurgitation associated with RV dilatation and dysfunction after primary RVOT reconstruction.

RESULTS

The surgical techniques varied in our series, but secondary repair of the incompetent pulmonary valve was possible in all patients. Follow-up was complete, with a mean follow-up of 4.1 +/- 2.7 years. There were no operative or late deaths in our group. All valves were repaired successfully, with a mean regurgitation grade of 1.28 +/- 0.5 postoperatively. The mean transvalvular gradient was 20 +/- 4.1 mm Hg for children and 22.5 +/- 3.5 mm Hg for adults, and no significant increase of pulmonary valve regurgitation occurred during follow-up. The mean RV dilatation index (RVDI) decreased significantly from 0.85 +/- 0.25 to 0.6 +/- 0.2 for children and from 1.4 +/- 0.01 to 0.9 +/- 0.05 for adults.

CONCLUSIONS

Our results showed functional recovery of the right ventricle after reoperation, with RVDI recovering to almost normal values in children. No significant regurgitation of the secondarily reconstructed pulmonary valve was observed during the 4-year follow-up period. Secondary repair for pulmonary valve incompetence after RVOT procedures might be a valuable alternative to conduit replacement.