Importance of pulmonary valve morphology for pulmonary valve preservation in tetralogy of Fallot surgery: comparison of the echocardiographic parameters
Background The decision to use transannular patching (TAP) during tetralogy of Fallot (TOF) repair depends on the pulmonary valve annulus size; the z score of the pulmonary annulus is the most commonly used predictor. However, definitive results are not obtained with z scores as different z score da...
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| Format: | Article |
| Language: | English |
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The Korean Pediatric Society
2020-05-01
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| Series: | Clinical and Experimental Pediatrics |
| Subjects: | |
| Online Access: | http://www.e-cep.org/upload/pdf/kjp-2019-01060.pdf |
| _version_ | 1819227957966667776 |
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| author | Su Jin Choi Jung Eun Kwon Da Eun Roh Myung Chul Hyun Han Na Jung Young Ok Lee Joon Yong Cho Yeo Hyang Kim |
| author_facet | Su Jin Choi Jung Eun Kwon Da Eun Roh Myung Chul Hyun Han Na Jung Young Ok Lee Joon Yong Cho Yeo Hyang Kim |
| author_sort | Su Jin Choi |
| collection | DOAJ |
| description | Background The decision to use transannular patching (TAP) during tetralogy of Fallot (TOF) repair depends on the pulmonary valve annulus size; the z score of the pulmonary annulus is the most commonly used predictor. However, definitive results are not obtained with z scores as different z score data sets are used for different parameters. Purpose This study aimed to identify the echocardiographic and other key factors that warranted a change in the surgical method during TOF surgery. Methods Sixty-two patients were enrolled and divided into a pulmonary valve (PV) preservation group and a TAP group. Their medical records were reviewed. Results The z score for PV annulus (PVA), ratio of the PVA to aortic annulus size, and ratio of PVA to descending aorta (DAO) size were significantly different between the PV preservation and TAP groups (-1.72±1.52 vs. -3.07±1.94, P=0.004; 0.62±0.12 vs. 0.50±0.14, P=0.002; and 1.32±0.32 vs. 1.07±0.36, P= 0.008, respectively). For TAP repair, the PVA z score had a sensitivity of 65.4% and specificity of 73.1%, ratio of PVA to aortic annulus size had a sensitivity of 73.1% and specificity of 65.4%, and ratio of PVA to DAO size had a sensitivity of 69.2% and specificity of 57.7%. The TAP group showed more monocuspid PVs (P=0.011), while the PV preservation group showed more tricuspid PVs (P=0.027). Commissurotomy was more frequently performed in the PV preservation group than in the TAP group (P=0.001). Of patients with commissurotomy, 58% showed a PV z score<-2. Conclusion Although various echocardiographic parameters may serve as predictors for determining surgical methods for TOF patients, the PV morphology and tissue characteristics should also be considered. |
| first_indexed | 2024-12-23T10:49:39Z |
| format | Article |
| id | doaj.art-c9aef419d6a444938ba84f1ff183f850 |
| institution | Directory Open Access Journal |
| issn | 2713-4148 |
| language | English |
| last_indexed | 2024-12-23T10:49:39Z |
| publishDate | 2020-05-01 |
| publisher | The Korean Pediatric Society |
| record_format | Article |
| series | Clinical and Experimental Pediatrics |
| spelling | doaj.art-c9aef419d6a444938ba84f1ff183f8502022-12-21T17:49:56ZengThe Korean Pediatric SocietyClinical and Experimental Pediatrics2713-41482020-05-0163518919410.3345/kjp.2019.0106020125553592Importance of pulmonary valve morphology for pulmonary valve preservation in tetralogy of Fallot surgery: comparison of the echocardiographic parametersSu Jin Choi0Jung Eun Kwon1Da Eun Roh2Myung Chul Hyun3Han Na Jung4Young Ok Lee5Joon Yong Cho6Yeo Hyang Kim7 Department of Pediatrics, School of Medicine, Kyungpook National University, Division of Pediatric Cardiology, Kyungpook National University Children's Hospital, Daegu, Korea Department of Pediatrics, School of Medicine, Kyungpook National University, Division of Pediatric Cardiology, Kyungpook National University Children's Hospital, Daegu, Korea Department of Pediatrics, School of Medicine, Kyungpook National University, Division of Pediatric Cardiology, Kyungpook National University Children's Hospital, Daegu, Korea Department of Pediatrics, School of Medicine, Kyungpook National University, Division of Pediatric Cardiology, Kyungpook National University Children's Hospital, Daegu, Korea Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Daegu, Korea Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Daegu, Korea Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Daegu, Korea Department of Pediatrics, School of Medicine, Kyungpook National University, Division of Pediatric Cardiology, Kyungpook National University Children's Hospital, Daegu, KoreaBackground The decision to use transannular patching (TAP) during tetralogy of Fallot (TOF) repair depends on the pulmonary valve annulus size; the z score of the pulmonary annulus is the most commonly used predictor. However, definitive results are not obtained with z scores as different z score data sets are used for different parameters. Purpose This study aimed to identify the echocardiographic and other key factors that warranted a change in the surgical method during TOF surgery. Methods Sixty-two patients were enrolled and divided into a pulmonary valve (PV) preservation group and a TAP group. Their medical records were reviewed. Results The z score for PV annulus (PVA), ratio of the PVA to aortic annulus size, and ratio of PVA to descending aorta (DAO) size were significantly different between the PV preservation and TAP groups (-1.72±1.52 vs. -3.07±1.94, P=0.004; 0.62±0.12 vs. 0.50±0.14, P=0.002; and 1.32±0.32 vs. 1.07±0.36, P= 0.008, respectively). For TAP repair, the PVA z score had a sensitivity of 65.4% and specificity of 73.1%, ratio of PVA to aortic annulus size had a sensitivity of 73.1% and specificity of 65.4%, and ratio of PVA to DAO size had a sensitivity of 69.2% and specificity of 57.7%. The TAP group showed more monocuspid PVs (P=0.011), while the PV preservation group showed more tricuspid PVs (P=0.027). Commissurotomy was more frequently performed in the PV preservation group than in the TAP group (P=0.001). Of patients with commissurotomy, 58% showed a PV z score<-2. Conclusion Although various echocardiographic parameters may serve as predictors for determining surgical methods for TOF patients, the PV morphology and tissue characteristics should also be considered.http://www.e-cep.org/upload/pdf/kjp-2019-01060.pdfechocardiographypulmonary valvesurgerytetralogy of fallot |
| spellingShingle | Su Jin Choi Jung Eun Kwon Da Eun Roh Myung Chul Hyun Han Na Jung Young Ok Lee Joon Yong Cho Yeo Hyang Kim Importance of pulmonary valve morphology for pulmonary valve preservation in tetralogy of Fallot surgery: comparison of the echocardiographic parameters Clinical and Experimental Pediatrics echocardiography pulmonary valve surgery tetralogy of fallot |
| title | Importance of pulmonary valve morphology for pulmonary valve preservation in tetralogy of Fallot surgery: comparison of the echocardiographic parameters |
| title_full | Importance of pulmonary valve morphology for pulmonary valve preservation in tetralogy of Fallot surgery: comparison of the echocardiographic parameters |
| title_fullStr | Importance of pulmonary valve morphology for pulmonary valve preservation in tetralogy of Fallot surgery: comparison of the echocardiographic parameters |
| title_full_unstemmed | Importance of pulmonary valve morphology for pulmonary valve preservation in tetralogy of Fallot surgery: comparison of the echocardiographic parameters |
| title_short | Importance of pulmonary valve morphology for pulmonary valve preservation in tetralogy of Fallot surgery: comparison of the echocardiographic parameters |
| title_sort | importance of pulmonary valve morphology for pulmonary valve preservation in tetralogy of fallot surgery comparison of the echocardiographic parameters |
| topic | echocardiography pulmonary valve surgery tetralogy of fallot |
| url | http://www.e-cep.org/upload/pdf/kjp-2019-01060.pdf |
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