{"title":"Monocusp pulmonary valve reconstruction in Tetralogy of Fallot: early results and evaluation using 2D echocardiography and 3-T cardiac MRI.","authors":"Sneha Daniel, Pranav Gupta, Kalpana Bansal, Arima Nigam, Saket Agarwal, Muhammed Abid Geelani","doi":"10.1007/s12055-025-01944-5","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Transannular patch (TAP) repair of right ventricular outflow tract (RVOT) in intracardiac repair of Tetralogy of Fallot (TOF) has been plagued by residual anatomic and hemodynamic abnormalities leading to mortality and morbidity. While efforts have been made to mitigate the effects of free pulmonary regurgitation (PR) following TAP repair, no single method demonstrated superior results. In this paper, we tried a novel method of monocusp pulmonary valve reconstruction using a strip of fixed autologous pericardium at the monocusp edge and assessed the early and mid-term results of the repair using two-dimensional (2D) echocardiography and cardiac magnetic resonance imaging (CMR).</p><p><strong>Methods: </strong>Ten consecutive patients who underwent intracardiac repair with TAP and monocusp reconstruction of pulmonary valve were studied. Postoperative 2D echocardiography and CMR were done to compare the diagnostic modalities.</p><p><strong>Results: </strong>Of the ten patients, nine were diagnosed to have only mild and low moderate PR on 2D echocardiography and regurgitant fraction of 10.8 to 28% on CMR during a follow-up period of 1 to 6 months using CMR, and one was diagnosed to have high moderate PR with regurgitant fraction 39.6%. Both the modalities had comparable results in diagnosing postoperative PR.</p><p><strong>Conclusion: </strong>Our method of pulmonary valve reconstruction is reasonable and provides good short-term and mid-term results in preventing postoperative PR. CMR is an excellent non-invasive operator-independent modality for the quantification of PR which provides a reproducible and comprehensive assessment of the repair and can be routinely used for the postoperative assessment of patients undergoing TAP repair of TOF.</p><p><strong>Graphical abstract: </strong>Schematic diagram A. The dotted line represents the incision extending from the right ventricular outflow tract to the main pulmonary artery, B. Visualising the native pulmonary valve anatomy C. the position of the monocusp represented in yellow, and the brown line demonstrating the strip of fixed pericardium D. Cross section of the right ventricular outflow tract- pulmonary artery junction with the position of monocusp with the thickening demonstrating the position of the strip of fixed pericardium.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 9","pages":"1165-1172"},"PeriodicalIF":0.6000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12373576/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian Journal of Thoracic and Cardiovascular Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s12055-025-01944-5","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/5/3 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Transannular patch (TAP) repair of right ventricular outflow tract (RVOT) in intracardiac repair of Tetralogy of Fallot (TOF) has been plagued by residual anatomic and hemodynamic abnormalities leading to mortality and morbidity. While efforts have been made to mitigate the effects of free pulmonary regurgitation (PR) following TAP repair, no single method demonstrated superior results. In this paper, we tried a novel method of monocusp pulmonary valve reconstruction using a strip of fixed autologous pericardium at the monocusp edge and assessed the early and mid-term results of the repair using two-dimensional (2D) echocardiography and cardiac magnetic resonance imaging (CMR).
Methods: Ten consecutive patients who underwent intracardiac repair with TAP and monocusp reconstruction of pulmonary valve were studied. Postoperative 2D echocardiography and CMR were done to compare the diagnostic modalities.
Results: Of the ten patients, nine were diagnosed to have only mild and low moderate PR on 2D echocardiography and regurgitant fraction of 10.8 to 28% on CMR during a follow-up period of 1 to 6 months using CMR, and one was diagnosed to have high moderate PR with regurgitant fraction 39.6%. Both the modalities had comparable results in diagnosing postoperative PR.
Conclusion: Our method of pulmonary valve reconstruction is reasonable and provides good short-term and mid-term results in preventing postoperative PR. CMR is an excellent non-invasive operator-independent modality for the quantification of PR which provides a reproducible and comprehensive assessment of the repair and can be routinely used for the postoperative assessment of patients undergoing TAP repair of TOF.
Graphical abstract: Schematic diagram A. The dotted line represents the incision extending from the right ventricular outflow tract to the main pulmonary artery, B. Visualising the native pulmonary valve anatomy C. the position of the monocusp represented in yellow, and the brown line demonstrating the strip of fixed pericardium D. Cross section of the right ventricular outflow tract- pulmonary artery junction with the position of monocusp with the thickening demonstrating the position of the strip of fixed pericardium.
期刊介绍:
The primary aim of the Indian Journal of Thoracic and Cardiovascular Surgery is education. The journal aims to dissipate current clinical practices and developments in the area of cardiovascular and thoracic surgery. This includes information on cardiovascular epidemiology, aetiopathogenesis, clinical manifestation etc. The journal accepts manuscripts from cardiovascular anaesthesia, cardiothoracic and vascular nursing and technology development and new/innovative products.The journal is the official publication of the Indian Association of Cardiovascular and Thoracic Surgeons which has a membership of over 1000 at present.DescriptionThe journal is the official organ of the Indian Association of Cardiovascular-Thoracic Surgeons. It was started in 1982 by Dr. Solomon Victor and ws being published twice a year up to 1996. From 2000 the editorial office moved to Delhi. From 2001 the journal was extended to quarterly and subsequently four issues annually have been printed out at time and regularly without fail. The journal receives manuscripts from members and non-members and cardiovascular surgeons. The manuscripts are peer reviewed by at least two or sometimes three or four reviewers who are on the panel. The manuscript process is now completely online. Funding the journal comes partially from the organization and from revenue generated by subscription and advertisement.