The right and left ventricular function after surgical correction with pericardial monocusp in tetralogy of Fallot: Mid-term result

Background: 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. Pericardial monocusp has recently been used at R...

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Main Authors: Worakan Promphan, Sukasom Attanawanit, Suthep Wanitkun, Pongsak Khowsathit
Other Authors: Mahidol University
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Published: 2018
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Online Access:https://repository.li.mahidol.ac.th/handle/123456789/20315
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spelling th-mahidol.203152018-07-24T10:04:10Z The right and left ventricular function after surgical correction with pericardial monocusp in tetralogy of Fallot: Mid-term result Worakan Promphan Sukasom Attanawanit Suthep Wanitkun Pongsak Khowsathit Mahidol University Medicine Background: 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. Pericardial monocusp has recently been used at Ramathibodi Hospital to preserve pulmonary valve function. Objectives: First, to study the competency of the pericardial 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 pericardial monocusp were recruited into group I and group II, respectively. The clinical symptoms, QRS duration from ECG, and cardio-thoracic (CT) ratio from CXR were analyzed. From the echocardiographic standpoint, the LV systolic function was determined by LV fractional shortening (LVFS), 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 1 and 7 years in group II (p<0.01). All patients in group I (100%) and 45 (80.4%) in group II had moderate or severe PR. The severity of PR, the RV and LV systolic functions were not statistically significantly different between the two groups (p>0.01). The median of the LVFS was 32.4 per cent, and of the TAPSE 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 pericardial 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. 2018-07-24T03:04:10Z 2018-07-24T03:04:10Z 2002-11-01 Article Journal of the Medical Association of Thailand. Vol.85, No.SUPPL. 4 (2002) 01252208 2-s2.0-0036880947 https://repository.li.mahidol.ac.th/handle/123456789/20315 Mahidol University SCOPUS https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=0036880947&origin=inward
institution Mahidol University
building Mahidol University Library
continent Asia
country Thailand
Thailand
content_provider Mahidol University Library
collection Mahidol University Institutional Repository
topic Medicine
spellingShingle Medicine
Worakan Promphan
Sukasom Attanawanit
Suthep Wanitkun
Pongsak Khowsathit
The right and left ventricular function after surgical correction with pericardial monocusp in tetralogy of Fallot: Mid-term result
description Background: 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. Pericardial monocusp has recently been used at Ramathibodi Hospital to preserve pulmonary valve function. Objectives: First, to study the competency of the pericardial 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 pericardial monocusp were recruited into group I and group II, respectively. The clinical symptoms, QRS duration from ECG, and cardio-thoracic (CT) ratio from CXR were analyzed. From the echocardiographic standpoint, the LV systolic function was determined by LV fractional shortening (LVFS), 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 1 and 7 years in group II (p<0.01). All patients in group I (100%) and 45 (80.4%) in group II had moderate or severe PR. The severity of PR, the RV and LV systolic functions were not statistically significantly different between the two groups (p>0.01). The median of the LVFS was 32.4 per cent, and of the TAPSE 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 pericardial 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.
author2 Mahidol University
author_facet Mahidol University
Worakan Promphan
Sukasom Attanawanit
Suthep Wanitkun
Pongsak Khowsathit
format Article
author Worakan Promphan
Sukasom Attanawanit
Suthep Wanitkun
Pongsak Khowsathit
author_sort Worakan Promphan
title The right and left ventricular function after surgical correction with pericardial monocusp in tetralogy of Fallot: Mid-term result
title_short The right and left ventricular function after surgical correction with pericardial monocusp in tetralogy of Fallot: Mid-term result
title_full The right and left ventricular function after surgical correction with pericardial monocusp in tetralogy of Fallot: Mid-term result
title_fullStr The right and left ventricular function after surgical correction with pericardial monocusp in tetralogy of Fallot: Mid-term result
title_full_unstemmed The right and left ventricular function after surgical correction with pericardial monocusp in tetralogy of Fallot: Mid-term result
title_sort right and left ventricular function after surgical correction with pericardial monocusp in tetralogy of fallot: mid-term result
publishDate 2018
url https://repository.li.mahidol.ac.th/handle/123456789/20315
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