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Pulmonary valve-sparing techniques during repair of tetralogy of Fallot: The delamination plasty

2016; Elsevier BV; Volume: 151; Issue: 6 Linguagem: Inglês

10.1016/j.jtcvs.2016.02.015

1097-685X

Vladimiro L. Vida, Fabio Zucchetta, Giovanni Stellin,

Cardiac Valve Diseases and Treatments

Central MessageThe delamination plasty allows the extension of pulmonary valve leaflet's coaptation surface during repair of tetralogy of Fallot.See Editorial Commentary page 1759.Video clip is available online. The delamination plasty allows the extension of pulmonary valve leaflet's coaptation surface during repair of tetralogy of Fallot. See Editorial Commentary page 1759. Video clip is available online. During the past decade, we embarked into a program for preserving the pulmonary valve (PV) function in selected patients during tetralogy of Fallot (TOF) repair, with the aim of preserving long-term right ventricular function. At the beginning of our experience, together with our standard early transatrial/transpulmonary repair1Stellin G. Milanesi O. Rubino M. Michielon G. Bianco R. Moreolo G.S. et al.Repair of tetralogy of Fallot in the first six months of life: transatrial versus transventricular approach.Ann Thorac Surg. 1995; 60: S588-S591Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar an intraoperative balloon dilation of the PV annulus was performed in selected patients with milder forms of TOF.2Vida V.L. Padalino M.A. Maschietto N. Biffanti R. Anderson R.H. Milanesi O. et al.The balloon dilation of the pulmonary valve during early repair of tetralogy of Fallot.Catheter Cardiovasc Interv. 2012; 80: 915-921Crossref PubMed Scopus (31) Google Scholar Progressively we treated more severe forms (PV z-score ≤−3) by combining additional PV plasty maneuvers, including the delamination plasty, to PV balloon dilatation.3Vida V.L. Zucchetta F. Padalino M.A. Milanesi O. Stellin G. Pulmonary valve-sparing technique in patients with tetralogy of Fallot and anomalous coronary artery crossing the infundibulum.J Heart Valve Dis. 2013; 22: 425-427PubMed Google Scholar, 4Vida V.L. Guariento A. Castaldi B. Sambugaro M. Padalino M.A. Milanesi O. et al.Evolving strategies for preserving the pulmonary valve during early repair of tetralogy of Fallot: mid-term results.J Thorac Cardiovasc Surg. 2014; 147 (discussion 694-6): 687-694Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar, 5Vida V.L. Angelini A. Guariento A. Frescura C. Fedrigo M. Padalino M. et al.Preserving the pulmonary valve during early repair of tetralogy of Fallot: anatomic substrates and surgical strategies.J Thorac Cardiovasc Surg. 2015; 149: 1358-1363.e1Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar In more severe forms, the balloon splays the PV commissures apart and therefore leaflets become insufficient to cover the new whole PV annular area. The delamination PV plasty is based on achieving more leaflet tissue for coaptation by delaminating with a fine scalpel the base of each PV cusp at the hinge point, occasionally extending the delamination into the right ventricular myocardium (Figures 1 and 2). Subsequently, the extended cusps are re-suspended for creating a new PV commissure, thus achieving an acceptable PV competence (Video 1). When leaflet tissue is lacking for PV cusp reconstruction, small triangles of prosthetic patch material can be added for extending the leaflets.Figure 2Intraoperative image of a 3.5-month-old patient with TOF and corresponding drawing showing the delamination plasty technique (arrow indicates the delaminated area).View Large Image Figure ViewerDownload Hi-res image Download (PPT) eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI2ZWI5MGM2NzhmNjQxMTgzNTcyNWZlNjk1NmZkNWYxNiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc4NjQ5ODgxfQ.Dk46bFXscId9NezU-_h0blQFBZLY-MXMZbGP1smJl81E0TjeXJCewvW8SX0YobtOeStwsU4sOf92WczfFCw1zpI_ZnyKkVz-Tck9_8WgyQvhBqYYnTTgZ4Nh8uNnK19kk6TG8co197XQhc64FoNwoSDY7rYjBDIgGVd6oyhw4bWRXoYfS8nV1R_QpbqU-3yJORFbKhHgj02roLdYNlZy5r1pp5tdbcxuW8rDx8SdWKqswsloWmCFqC_ciAsN9wuZKSgtp9OkP423NvaZzDPU24haSxFUWmPItsUDpJs6iogjWgG4AgoYs4I4BVhtD-d9EoJXGApeqvRlDDLC6TtuUA Download .mp4 (155.97 MB) Help with .mp4 files Video 1Video showing the preservation of the PV in a 3.5-month-old male patient during transatrial/transpulmonary TOF repair (PV commissurotomy, intraoperative balloon dilation, extensive PV leaflet delamination plasty and commissure resuspension). Preoperative 2-deminsional echo PV z-score: −4.8.