ABSTRACT
BACKGROUND: A plethora of valves and valve conduits are available for reconstruction of the right ventricular outflow tract (RVOT) for grown-up congenital heart patients. However, for several reasons, the ideal pulmonary valve substitute still remains the subject of debate. In this study, we investigated the preliminary clinical and echocardiographic results after implantation of the RVOT Elan (Vascutek, Renfrewshire, United Kingdom) conduit in adolescents and adults. MATERIAL AND METHODS: Between October 2012 and December 2014, a total of 27 patients (19 males, mean age: 23.7 ± 22.5; range: 9-74 years) received a RVOT Elan conduit for RVOT reconstruction and were prospectively followed up clinically and echocardiographically. Twenty-five patients had previous cardiac surgery. The median number of prior operations per patient was 2 (range: 1-4). Tetralogy of Fallot was the most common diagnosis (n = 7). RESULTS: At a mean follow-up time of 0.9 ± 0.61 years (100% complete), all patients (27 of 27) were alive and in New York Heart Association Class I. Adverse events defined as valve failure, thrombosis, embolism, bleeding, or endocarditis did not occur. Freedom from reoperation in general was 100%. At 1-year follow-up, median peak pressure gradients (Δ Pmax) across the RVOT Elan conduit were 15 ± 3.2; 15.3 ± 2.1Δ, 16 ± 4.8, and 16.3 ± 5.1 mm Hg for the 19 (n = 3), 21 (n = 3), 23 (n = 6), and 25 mm (n = 15) conduit size, respectively. CONCLUSION: The RVOT Elan conduit revealed excellent preliminary clinical and hemodynamic performances independent from the underlying cardiac pathology with insignificant transvalvular gradients and nonturbulent flow characteristics.
Subject(s)
Bioprosthesis , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis , Heart Defects, Congenital/surgery , Heart Valve Prosthesis Implantation/instrumentation , Heart Valve Prosthesis , Pulmonary Artery/transplantation , Pulmonary Valve/transplantation , Adolescent , Adult , Aged , Blood Vessel Prosthesis Implantation/adverse effects , Child , Female , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/physiopathology , Heart Valve Prosthesis Implantation/adverse effects , Hemodynamics , Humans , Male , Middle Aged , Postoperative Complications/etiology , Prosthesis Design , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/physiopathology , Pulmonary Valve/diagnostic imaging , Pulmonary Valve/physiopathology , Reoperation , Retrospective Studies , Time Factors , Treatment Outcome , Young AdultABSTRACT
An anomalous origin of the left circumflex coronary artery that arises as a side branch of the right coronary artery from the right coronary sinus of Valsalva encircling the aortic annulus is usually an incidental finding. However, in patients undergoing aortic valve procedures, its existence can significantly complicate the surgical treatment. We report our operative strategy in patients with an anomalous left circumflex coronary artery, a bicuspid aortic valve morphology and different aortic valve pathologies.
