ANATOMICAL AND PHYSIOLOGICAL CONDITION OF THE RIGHT VENTRICLE AFTER SURGICAL REPAIR OF PATIENTS WITH TETRALOGY OF FALLOT
Objectives: to investigate the results of surgical repair in patients with tetralogy of Fallot underwent transannular outflow plasty and reconstruction with preservation of the right ventricular outflow structures. Methods. 158 patients were investigated after TOF repair. Most patients had undergone primary surgical repair under the first year of life (81.1 %). All patients were divided in 2 main groups: 1 group (RVISS) – preservation of the right ventricular outflow structures, which includes three subgroups: a) TATP – transatrial-transpulmonary reconstruction (20 patients), b) RVOT – isolated reconstruction of the right ventricular infundibulum (26 patients), and c) TwoPatch – two patch plasty with preservation of the pulmonary valve (17 patients); 2 group (TAP) – transannular right ventricular outflow tract reconstruction (95 patients), which includes a subgroup of patients with monocusp (TAPm, 28 patients). Results. Normal diastolic function of the right ventricle in late postoperative period occurs in 7 times more often in the RVISS group, and in 25 times more often than after transannular plasty. A rigid type of diastolic dysfunction of the right ventricle occurs in similar fashion in both groups, however, restriction of the right ventricle occurs in 2,8 times more often in patients after ventriculomy in the RVISS group, and in 4 times more often in the TAP group. Impairment of systolic function of the right ventricle appears significantly less often in the RVISS group. 67.7 % patients with residual RVOT gradient higher than 30 mm Hg had significant reduction of ОСГ within 4–10 years. Patients from the RVISS group rarely had symptomatic chronic heart failure required therapy in late follow-up period. Conclusion. Surgical repair of tetralogy of Fallot with preservation of the right ventricular outflow structures significantly improves diastolic and systolic right ventricular functions, it also affects favorably on electrophysiology of the right ventricle and on hemodynamic of both tricuspid and pulmonary valves.
About Authors (Correspondence):
Voytov A.V. – cardio-vascular surgeon of cardio-surgical department of congenital heart disorders, researcher of center for novel surgical technologies