This video highlights a pulmonary valve replacement in a patient with Tetralogy of Fallot.
Pulmonary valve replacement
Severe Pulmonary Insufficiency on echocardiogram.
Moderately dilated right ventricle with an EDV of 100 mL/m^2 , ESV of 56 mL/m^2 , SV of 72 mL, and Ejection Fraction of 44% on MRI.
Bicaval cardiopulmonary bypass, Patent was given 15ml/kg of Del Nido cardioplegia solution and kept normothermic throughout the case.
Transthoracic echocardiogram, Cardiac MRI
TOF with PA, S/P Monocuspid Gortex leaflet graft
Preservation of the right ventricle (cardiac remodeling) and surgical repair of the PI.
Use of bioprosthetic valves are unique in that catheter based valve-in-valve replacement options may be available in the future.
Risks include: Redo sternotomy, injury to coronary arteries with dissection of the RVOT and compression of coronary with malposition of the prosthetic Pulmonary valve
Comprehensive Surgical management of Congenital Heart Disease – Richard Jonas ISBN: 978-1-4441-1215-3
McKenzie, E. D., Khan, M. S., Dietzman, T. W., Guzmán-Pruneda, F. A., Samayoa, A. X., Liou, A., Heinle, J. S., & Fraser, C. D., Jr (2014). Surgical pulmonary valve replacement: a benchmark for outcomes comparisons. The Journal of thoracic and cardiovascular surgery, 148(4), 1450–1453. https://doi.org/10.1016/j.jtcvs.2014.02.060
Tatewaki, H., & Shiose, A. (2018). Pulmonary valve replacement after repaired Tetralogy of Fallot. General thoracic and cardiovascular surgery, 66(9), 509–515. https://doi.org/10.1007/s11748-018-0931-0