Abstract： With the evolvement of surgical, anesthetic, perfusion, and perioperative management techniques, the mortality of routine corrective operation of tetralogy of Fallot（TOF） has been less than 2%-3%, while more and more attention has been paid to patient long-term prognosis. Chronic postoperative pulmonary regurgitation （PR） is one of the important prognostic factors which are puzzling cardiac surgeons. Subsequent right ventricle dilation, right ventricular dysfunction and fatal arrhythmias as chronic PR complications have important impact on the postoperative quality of life and long-term survival. Current treatment choice for PR includes pulmonary valve replacement（PVR）, intervention, and hybrid procedures. PVR is the main surgical method for chronic PR which can significantly improve patient cardiac function and clinical symptoms，and prolong long-term survival. Intervention does not require thoracotomy once again, and can thus reduce surgical trauma and risks. Intervention is also helpful to improve right ventricular pressure conditions and PR degree. This article focuses on the pathophysiological changes of chronic PR after surgical repair of TOF, surgical indications for PVR, clinical treatment progress and early prevention of PR.
This article reports a 16-year-old patient with severe pulmonary valve regurgitation after corrective surgery for tetralogy of Fallot. The shape of the right ventricular outflow tract to the main pulmonary artery was cone-shaped, which is extremely challenging. After admission, percutaneous pulmonary valve replacement with self-expanding valve was successfully performed. The patient’s condition remained stable during the 2-year follow-up period after surgery. This case aims to provide a reference for percutaneous pulmonary valve replacement in patients with cone-shaped right ventricular outflow tract.