(IV- 2A.1) Patient after corection of Tetralogy of Fallot with pulmonary valve regurgitation Natalia Dłużniewska MD, Lidia Tomkiewicz-Pająk MD, PhD, Assoc. Prof. Maria Olszowska MD, PhD, Prof. Piotr Podolec MD, PhD

 

BRIEF COMMENTS

EXPERT: Prof. Piotr Podolec
Affiliation: Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
COMMENT
Despite the lack of symptoms there is a significant leakage, reduced contractility of the left and right ventricle and the pulmonary artery trunk extension. It seems reasonable to close of atrial septal defect – to consider is the choice of method (percutaneous using Amplatz device or surgical, which additional advantage is a possibility of leaving a little septal communication as a kind of “safety valve” for the right ventricle).
EXPERT: Dr Lidia Tomkiewicz-Pająk
Affiliation: Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
COMMENT
Complete closure of the defect has to be carefully considered. The right ventricle shows reduced contractility and foci of fibrosis. Leaving little communication between the atria could relieve pressure in the right ventricle in new postoperative hemodynamic conditions.

EXPERT: Doc. Bogusław Kapelak
Affiliation: Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
COMMENT
Pulmonary valve replacement and closure of interatrial defect seems reasonable. The evaluation of the left pulmonary branch by an invasive cardiologist to be considered. Surgical intervention in terms of the right ventricular muscle does not seem justified.

EXPERT: Prof. Zbigniew Kordon
Affiliation: Department of Pediatric Cardiology, Jagiellonian University Medical College, Krakow, Poland
COMMENT
High degree leakage, severe pulmonary valve regurgitation and expansion of the right pulmonary branch was revealed (which may indicate a preferential blood flow in this way due to the narrowing of the left branch). Pulmonary valve replacement and closure of interatrial defect with postoperative follow-up assessment of the influence of hemodynamic changes on tricuspid regurgitation is reasonable.

CONCLUSIONS

1. The patient is eligible for surgical treatment. The proposed treatment is in two phases: stage I – percutaneous closure of the ASD, stage II – surgical pulmonary valve implantation. There are no indications to extend the left pulmonary branch.
2 The patient should be familiar with the proposed surgical treatment and possible risk and benefits of the proposed management.


“Development of the European Network in Orphan Cardiovascular Diseases”
„Rozszerzenie Europejskiej Sieci Współpracy ds. Sierocych Chorób Kardiologicznych”

This entry was posted in 1. Tetralogy of Fallot, 2. Shunts, A. Decreased pulmonary flow, Case presentations, IV. Rare congenital cardiovascular diseases. Bookmark the permalink.

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