Monocusp pulmonary valve reconstruction in Tetralogy of Fallot: early results and evaluation using 2D echocardiography and 3-T cardiac MRI

BackgroundTransannular patch (TAP) repair of right ventricular outflow tract (RVOT) in intracardiac repair of Tetralogy of Fallot (TOF) has been plagued by residual anatomic and hemodynamic abnormalities leading to mortality and morbidity. While efforts have been made to mitigate the effects of free pulmonary regurgitation (PR) following TAP repair, no single method demonstrated superior results. In this paper, we tried a novel method of monocusp pulmonary valve reconstruction using a strip of fixed autologous pericardium at the monocusp edge and assessed the early and mid-term results of the repair using two-dimensional (2D) echocardiography and cardiac magnetic resonance imaging (CMR).MethodsTen consecutive patients who underwent intracardiac repair with TAP and monocusp reconstruction of pulmonary valve were studied. Postoperative 2D echocardiography and CMR were done to compare the diagnostic modalities.ResultsOf the ten patients, nine were diagnosed to have only mild and low moderate PR on 2D echocardiography and regurgitant fraction of 10.8 to 28% on CMR during a follow-up period of 1 to 6 months using CMR, and one was diagnosed to have high moderate PR with regurgitant fraction 39.6%. Both the modalities had comparable results in diagnosing postoperative PR.ConclusionOur method of pulmonary valve reconstruction is reasonable and provides good short-term and mid-term results in preventing postoperative PR. CMR is an excellent non-invasive operator-independent modality for the quantification of PR which provides a reproducible and comprehensive assessment of the repair and can be routinely used for the postoperative assessment of patients undergoing TAP repair of TOF.Graphical abstractSchematic diagram A. The dotted line represents the incision extending from the right ventricular outflow tract to the main pulmonary artery, B. Visualising the native pulmonary valve anatomy C. the position of the monocusp represented in yellow, and the brown line demonstrating the strip of fixed pericardium D. Cross section of the right ventricular outflow tract- pulmonary artery junction with the position of monocusp with the thickening demonstrating the position of the strip of fixed pericardium.