Proportion of pulmonary valve annulus: A new predictive index for transannular patch in repair of tetralogy of Fallot_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CAI Xiaowei ¹ , ZHAO Junfei ² , LIU Xiaobing ² , CHEN Jimei ² , CEN Jianzheng ² , WEN Shusheng ² , XU Gang ² , CUI Hujun ² , QIU Hailong ¹ ,  ZHUANG Jian ^1,2

1. Department of Cardiac Surgery, Guangdong General Hospital Affiliated to South China University of Technology, Guangzhou, 510100, P.R.China;
2. Guangdong Cardiovascular Institute, Guangzhou, 510080, P.R.China;

Corresponding author：

ZHUANG Jian, Email: zhuangjian5413@tom.com

Keywords：

Tetralogy of Fallot; transannular patch; pulmonary valvular annulus; z-score; proportion of pulmonary valvular annulus

DOI：

10.7507/1007-4848.201809043

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Objective To investigate if the ratio of pulmonary valve annulus, which is the proportion of pulmonary valvular annulus size to total size of aortic valvular annulus and pulmonary valvular annulus, can better guide the choice of surgical approach than the value of z.Methods A retrospective analysis was made for 254 patients who underwent total correction of tetralogy of Fallot in Guangdong General Hospital between January 2016 and January 2018. There were 154 males and 100 females with an average age of 14.60±18.76 years. The patients were categorized into two groups, a transannular patch group (TAP, n=164) and a non-TAP group (n=90). The sizes of pulmonary and aortic valvular annulus were evaluated in each group, and the cutoff value of proportion of pulmonary valvular annulus for TAP was calculated.Results Both proportion of pulmonary valvular annulus and z-scores were smaller in the TAP group than those in the non-TAP group (0.29±0.06 vs. 0.36±0.06, P<0.001; –4.04±2.13 vs. –2.06±1.84, P<0.001, respectively). In receiver operating characteristics analyses, proportion of pulmonary valvular annulus and the z-score cutoff values were 0.353 (area under the curve 0.781, 95%CI 0.725–0.831) and –2.13 (area under the curve 0.766, 95%CI 0.709–0.817), respectively, demonstrating that the proportion of pulmonary valvular annulus was a more powerful diagnostic tool as a predictor of TAP.Conclusion Our results suggest that the proportion of pulmonary valvular annulus is an effective predictor for TAP and can be easily applied to clinical practice.

Citation： CAI Xiaowei, ZHAO Junfei, LIU Xiaobing, CHEN Jimei, CEN Jianzheng, WEN Shusheng, XU Gang, CUI Hujun, QIU Hailong, ZHUANG Jian. Proportion of pulmonary valve annulus: A new predictive index for transannular patch in repair of tetralogy of Fallot. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(4): 316-320. doi: 10.7507/1007-4848.201809043 Copy

1.	Apitz C, Webb GD, Redington AN. Tetralogy of Fallot. Lancet, 2009, 374(9699): 1462-1471.
2.	Stellin G, Milanesi O, Rubino M, et al. Repair of tetralogy of Fallot in the first six months of life: transatrial versus transventricular approach. Ann Thorac Surg, 1995, 60(6 Suppl): S588-S591.
3.	Padalino MA, Cavalli G, Albanese SB, et al. Long-term outcomes following transatrial versus transventricular repair on right ventricular function in tetralogy of Fallot. J Card Surg, 2017, 32(11): 712-720.
4.	Karl TR, Sano S, Pornviliwan S, et al. Tetralogy of Fallot: favorable outcome of nonneonatal transatrial, transpulmonary repair. Ann Thorac Surg, 1992, 54(5): 903-907.
5.	Giannopoulos NM, Chatzis AK, Karros P, et al. Early results after transatrial/transpulmonary repair of tetralogy of Fallot. Eur J Cardiothorac Surg, 2002, 22(4): 582-586.
6.	Jonas RA. Early primary repair of tetralogy of Fallot. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2009: 39-47.
7.	Stewart RD, Backer CL, Young L, et al. Tetralogy of Fallot: results of a pulmonary valve-sparing strategy. Ann Thorac Surg, 2005, 80(4): 1431-1438.
8.	Awori MN, Finucane K, Gentles TL. Optimal normative pediatric cardiac structure dimensions for clinical use. World J Pediatr Congenit Heart Surg, 2011, 2(1): 85-89.
9.	Kasturi S, Balaji S, Sudhakar A, et al. Accuracy of a new echocardiographic index to predict need for trans-annular patch in tetralogy of Fallot. Pediatr Cardiol, 2018, [Epub ahead of print].
10.	Schultz C, Moelker A, Tzikas A, et al. The use of MSCT for the evaluation of the aortic root before transcutaneous aortic valve implantation: the Rotterdam approach. EuroIntervention, 2010, 6(4): 505-511.
11.	万俊义, 王恩宁, 蒋世良, 等. 计算机断层摄影术在经皮肺动脉瓣植入术的应用及评价. 中国循环杂志, 2017, 32(5): 489-492.
12.	Zilberman MV, Khoury PR, Kimball RT. Two-dimensional echocardiographic valve measurements in healthy children: gender-specific differences. Pediatr Cardiol, 2005, 26(4): 356-360.
13.	Fraser CD Jr, McKenzie ED, Cooley DA. Tetralogy of Fallot: surgical management individualized to the patient. Ann Thorac Surg, 2001, 71(5): 1556-1561.
14.	Bhagra CJ, Hickey EJ, Van De Bruaene A, et al. Pulmonary valve procedures late after repair of tetralogy of Fallot: current perspectives and contemporary approaches to management. Can J Cardiol, 2017, 33(9): 1138-1149.
15.	Bouzas B, Kilner PJ, Gatzoulis MA. Pulmonary regurgitation: not a benign lesion. Eur Heart J, 2005, 26(5): 433-439.
16.	Karamlou T, McCrindle BW, Williams WG. Surgery insight: late complications following repair of tetralogy of Fallot and related surgical strategies for management. Nat Clin Pract Cardiovasc Med, 2006, 3(11): 611-622.
17.	Gatzoulis MA, Balaji S, Webber SA, et al. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. Lancet, 2000, 356(9234): 975-981.
18.	Al Habib HF, Jacobs JP, Mavroudis C, et al. Contemporary patterns of management of tetralogy of Fallot: data from the Society of Thoracic Surgeons Database. Ann Thorac Surg, 2010, 90(3): 813-819.
19.	Luijten LW, van den Bosch E, Duppen N, et al. Long-term outcomes of transatrial-transpulmonary repair of tetralogy of Fallot. Eur J Cardiothorac Surg, 2015, 47(3): 527-534.
20.	Awori MN, Mehta NP, Mitema FO, et al. Optimal use of Z-scores to preserve the pulmonary valve annulus during repair of tetralogy of Fallot. World J Pediatr Congenit Heart Surg, 2018, 9(3): 285-288.

1. Apitz C, Webb GD, Redington AN. Tetralogy of Fallot. Lancet, 2009, 374(9699): 1462-1471.
2. Stellin G, Milanesi O, Rubino M, et al. Repair of tetralogy of Fallot in the first six months of life: transatrial versus transventricular approach. Ann Thorac Surg, 1995, 60(6 Suppl): S588-S591.
3. Padalino MA, Cavalli G, Albanese SB, et al. Long-term outcomes following transatrial versus transventricular repair on right ventricular function in tetralogy of Fallot. J Card Surg, 2017, 32(11): 712-720.
4. Karl TR, Sano S, Pornviliwan S, et al. Tetralogy of Fallot: favorable outcome of nonneonatal transatrial, transpulmonary repair. Ann Thorac Surg, 1992, 54(5): 903-907.
5. Giannopoulos NM, Chatzis AK, Karros P, et al. Early results after transatrial/transpulmonary repair of tetralogy of Fallot. Eur J Cardiothorac Surg, 2002, 22(4): 582-586.
6. Jonas RA. Early primary repair of tetralogy of Fallot. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2009: 39-47.
7. Stewart RD, Backer CL, Young L, et al. Tetralogy of Fallot: results of a pulmonary valve-sparing strategy. Ann Thorac Surg, 2005, 80(4): 1431-1438.
8. Awori MN, Finucane K, Gentles TL. Optimal normative pediatric cardiac structure dimensions for clinical use. World J Pediatr Congenit Heart Surg, 2011, 2(1): 85-89.
9. Kasturi S, Balaji S, Sudhakar A, et al. Accuracy of a new echocardiographic index to predict need for trans-annular patch in tetralogy of Fallot. Pediatr Cardiol, 2018, [Epub ahead of print].
10. Schultz C, Moelker A, Tzikas A, et al. The use of MSCT for the evaluation of the aortic root before transcutaneous aortic valve implantation: the Rotterdam approach. EuroIntervention, 2010, 6(4): 505-511.
11. 万俊义, 王恩宁, 蒋世良, 等. 计算机断层摄影术在经皮肺动脉瓣植入术的应用及评价. 中国循环杂志, 2017, 32(5): 489-492.
12. Zilberman MV, Khoury PR, Kimball RT. Two-dimensional echocardiographic valve measurements in healthy children: gender-specific differences. Pediatr Cardiol, 2005, 26(4): 356-360.
13. Fraser CD Jr, McKenzie ED, Cooley DA. Tetralogy of Fallot: surgical management individualized to the patient. Ann Thorac Surg, 2001, 71(5): 1556-1561.
14. Bhagra CJ, Hickey EJ, Van De Bruaene A, et al. Pulmonary valve procedures late after repair of tetralogy of Fallot: current perspectives and contemporary approaches to management. Can J Cardiol, 2017, 33(9): 1138-1149.
15. Bouzas B, Kilner PJ, Gatzoulis MA. Pulmonary regurgitation: not a benign lesion. Eur Heart J, 2005, 26(5): 433-439.
16. Karamlou T, McCrindle BW, Williams WG. Surgery insight: late complications following repair of tetralogy of Fallot and related surgical strategies for management. Nat Clin Pract Cardiovasc Med, 2006, 3(11): 611-622.
17. Gatzoulis MA, Balaji S, Webber SA, et al. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. Lancet, 2000, 356(9234): 975-981.
18. Al Habib HF, Jacobs JP, Mavroudis C, et al. Contemporary patterns of management of tetralogy of Fallot: data from the Society of Thoracic Surgeons Database. Ann Thorac Surg, 2010, 90(3): 813-819.
19. Luijten LW, van den Bosch E, Duppen N, et al. Long-term outcomes of transatrial-transpulmonary repair of tetralogy of Fallot. Eur J Cardiothorac Surg, 2015, 47(3): 527-534.
20. Awori MN, Mehta NP, Mitema FO, et al. Optimal use of Z-scores to preserve the pulmonary valve annulus during repair of tetralogy of Fallot. World J Pediatr Congenit Heart Surg, 2018, 9(3): 285-288.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Proportion of pulmonary valve annulus: A new predictive index for transannular patch in repair of tetralogy of Fallot

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