Heart, Lung and Circulation
Original Article| Volume 16, ISSUE 2, P107-112, April 2007

A New Technique of Transannular Monocusp Patch-Repair of the Right Ventricular Outflow Tract in Repair of Tetralogy of Fallot

  • Guo-Wei He
    Correspondence address: Department of Cardiac Surgery, The Central Hospital of Wuhan, 26 Sheng Li Street, Wuhan, China. Tel: 86 27 82780633.
    Wuhan Heart Institute, The Central Hospital of Wuhan, Wuhan, China

    Starr Academic Center, St. Vincent Heart & Vascular Institute, Department of Surgery, Oregon Health and Science University, Portland, OR, USA

    Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
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      Reconstruction of the right ventricular outflow tract (RVOT) is a key procedure in repair of Tetralogy of Fallot (TOF). The procedure creates pulmonary insufficiency (PI) that may compromise the right ventricular (RV) function, particularly during late follow-up. A simple way to reduce PI is to create a monocusp patch from xenografts, homografts, fascia lata, and autologous pulmonary artery or pericardium. Each of those has limitations. The autologous pericardial valve sewn on another pericardial patch is one of the earliest monocusp patches used clinically but loses anti-PI effect soon after the operation presumably due to degeneration or absorption of the monocusp. I have therefore designed and used a new technique (folded monocusp patch) to create a monocusp for TOF repair in children and adults. The technique has been used in nine patients of the 18 TOF patients who needed transannular patch-repair in total 74 TOF repairs. The monocusp patch-repaired patients had minimal or mild PI and good RV function beyond 8–12 months. The long-term results await follow-up and further study in multi-institutions.


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        • Bove E.L.
        • Byrum C.J.
        • Thomas F.D.
        • Kavey R.E.
        • Sondheimer H.M.
        • Blackman M.S.
        • Parker Jr., F.B.
        The influence of pulmonary insufficiency on ventricular function following repair of tetralogy of Fallot. Evaluation using radionuclide ventriculography.
        J Thorac Cardiovasc Surg. 1983; 85: 691-696
        • Roughneen P.T.
        • DeLeon S.Y.
        • Parvathaneni S.
        • Cetta F.
        • Eidem B.
        • Vitullo D.A.
        The pericardial membrane pulmonary monocusp: surgical technique and early results.
        J Card Surg. 1999; 14: 370-374
        • Borowski A.
        • Ghodsizad A.
        • Litmathe J.
        • Lawrenz W.
        • Schmidt K.G.
        • Gams E.
        Severe pulmonary regurgitation late after total repair of tetralogy of Fallot: surgical considerations.
        Pediatr Cardiol. 2004; 25 (Epub 2004 Mar 4): 466-471
        • Conte S.
        • Jashari R.
        • Eyskens B.
        • Gewillig M.
        • Dumoulin M.
        • Daenen W.
        Homograft valve insertion for pulmonary regurgitation late after valveless repair of right ventricular outflow tract obstruction.
        Eur J Cardiothorac Surg. 1999; 15: 143-149
        • Giannopoulos N.M.
        • Chatzis A.C.
        • Bobos D.P.
        • Kirvassilis G.V.
        • Tsoutsinos A.
        • Sarris G.E.
        Tetralogy of Fallot: influence of right ventricular outflow tract reconstruction on late outcome.
        Int J Cardiol. 2004; 97: 87-90
        • Bigras J.L.
        • Boutin C.
        • McCrindle B.W.
        • Rebeyka I.M.
        Short-term effect of monocuspid valves on pulmonary insufficiency and clinical outcome after surgical repair of tetralogy of Fallot.
        J Thorac Cardiovasc Surg. 1996; 112: 33-37
        • Bogers A.J.
        • Roofthooft M.
        • Pisters H.
        • Spitaels S.E.
        • Bos E.
        Long-term results of the gamma-irradiation-preserved homograft monocusp for transannular reconstruction of the right-ventricular outflow tract in tetralogy of Fallot.
        Thorac Cardiovasc Surg. 1994; 42: 337-339
        • Sievers H.H.
        • Lange P.E.
        • Regensburger D.
        • Yankah C.A.
        • Onnasch D.G.
        • Bursch J.
        • Heintzen P.H.
        • Bernhard A.
        Short-term hemodynamic results after right ventricular outflow tract reconstruction using a cusp-bearing transannular patch.
        J Thorac Cardiovasc Surg. 1983; 86: 777-783
        • Revuelta J.M.
        • Ubago J.L.
        • Duran C.M.
        Composite pericardial monocusp patch for the reconstruction of right ventricular outflow tract.
        Thorac Cardiovasc Surg. 1983; 31: 156-159
        • Gundry S.R.
        • Razzouk A.J.
        • Boskind J.F.
        • Bansal R.
        • Bailey L.L.
        Fate of the pericardial monocusp pulmonary valve for right ventricular outflow tract reconstruction.
        J Thorac Cardiovasc Surg. 1994; 107: 908-913
        • Shatapathy P.
        • Aggarwal B.K.
        • Kamath S.G.
        • Sai S.
        Pulmonary valve reconstruction in absent pulmonary valve syndrome: a new technique.
        J Card Surg. 1997; 12: 180-184
        • He G.W.
        • Kuo C.C.
        • Mee R.B.
        Pulmonic regurgitation and reconstruction of right ventricular outflow tract with patch. An experimental study.
        J Thorac Cardiovasc Surg. 1986; 92: 128-137
        • Turrentine M.W.
        • McCarthy R.P.
        • Vijay P.
        • McConnell K.W.
        • Brown J.W.
        PTFE monocusp valve reconstruction of the right ventricular outflow tract.
        Ann Thorac Surg. 2002; 73: 871-880
        • Norgard G.
        • Gatzoulis M.A.
        • Moraes F.
        • Lincoln C.
        • Shore D.F.
        • Shinebourne E.A.
        • Redington A.N.
        Relationship between type of outflow tract repair and postoperative right ventricular diastolic physiology in tetralogy of Fallot. Implications for long-term outcome.
        Circulation. 1996; 904: 3276-3280
        • Yankah A.C.
        • Lange P.E.
        • Sievers H.H.
        • Radtke W.
        • Regensburger D.
        • Heintzen P.H.
        • Bernhard A.
        Late results of valve xenograft conduits between the right ventricle and the pulmonary arteries in patients with pulmonary atresia and extreme tetralogy of Fallot.
        Thorac Cardiovasc Surg. 1984; 32: 250-252