ObjectiveTo evaluate mid-term outcomes of pulmonary valve replacement surgery after repair of tetralogy of Fallot.MethodsA total of 73 patients with repaired tetralogy of Fallot who underwent pulmonary valve replacement surgery in our hospital from January 2010 to January 2020 were enrolled, including 42 males and 31 females. The median age was 3.9 (0.2-42.8) years at initial repair and 20.0 (2.0-50.0) years at pulmonary valve replacement. The clinical data of the patients were recorded and analyzed.ResultsThere was no death in postoperative 30 d. The average follow-up time was 35.6±28.5 months, and no death occurred during the follow-up. One patient underwent a second reintervention after initial pulmonary valve replacement. The 1- and 5-year survival rates were both 100.0%, the 1- and 5-year reintervention-free rates were both 100.0%, and the 1- and 5-year valve failure-free rates were 100.0% and 67.1%. There was no significant difference in valve failure-free rates between different age groups (P=0.49) and different type of valve groups (P=0.74). The right (P=0.006) and left (P=0.002) ventricular ejection fractions were significantly improved, and the QRS duration was shortened after pulmonary valve replacement (P=0.006).ConclusionMid-term outcomes of surgical pulmonary valve replacement were satisfactory in patients with repaired tetralogy of Fallot, while the long-term effects should be further emphasized in clinical practice.
Objective To assess the clinical efficacy of endovascular treatment in the second stage for patients with progression to local or full-length dissection-like changes at the distal aorta following initial surgery for aortic intramural hematoma. Methods Between July 2020 and December 2022, patients with aortic intramural hematoma were treated initially for proximal lesions. During follow-up, if the distal aortic hematoma was not resorbed and entry tears were identified with progression to local or full-length dissection-like changes and possible focal contrast enhancement, and the patients undergoing a second-stage stent intervention were retrospectively collected. Initial surgeries included total aortic arch replacement or thoracic endovascular aortic repair (TEVAR) targeting the proximal entry tear. In the secondary stage, stents were strategically placed in three delineated regions of the distal aorta to seal the entry tears, promote hematoma resorption, and induce thrombosis of the false lumen. Results A total of 18 patients were collected, including 15 males and 3 females with a mean age of 53.5±10.6 years, ranging from 39 to 76 years. All patients achieved procedural success, yielding a technical success rate of 100%. Intraoperative and postoperative imaging confirmed effective sealing of the distal entry tears without stent leakage, visceral branch stenosis, or occlusion, and there were no serious complications such as perioperative cerebral infarction, paraplegia, or organ ischemia. Follow-up assessments showed complete thrombosis and disappearance of the false lumen in all patients. Conclusion In patients with unresolved entry tears and dissection-like changes post-initial surgery for aortic intramural hematoma, secondary stent placement effectively seals these tears, promotes thrombosis and resorption of the hematoma, and improves endovascular remodeling of the aorta, demonstrating favorable short- to medium-term outcomes.