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Clin Exp Pediatr > Accepted Articles
DOI: https://doi.org/10.3345/kjp.2019.01060    [Accepted]
Published online November 8, 2019.
Importance of Pulmonary Valve Morphology for Pulmonary Valve Preservation in Tetralogy of Fallot Surgery: Comparison of Echocardiographic Parameters
Su Jin Choi1, Jung Eun Kwon1, Da Eun Roh1, Myung Chul Hyun1, Han Na Jung2, Young Ok Lee2, Joon Yong Cho2, Yeo Hyang Kim1 
1Department of Pediatrics, School of Medicine, Kyungpook National University, Division of Pediatric Cardiology, Kyungpook National University Children's Hospital, Daegu, Republic of Korea
2Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
Correspondence: 
Yeo Hyang Kim, Tel: +82-53-200-3757, Fax: +82-53-425-6683, Email: kimyhmd@knu.ac.kr
Received: 7 September 2019   • Revised: 6 November 2019   • Accepted: 6 November 2019
Abstract
Background
The decision for transannular patching (TAP) during tetralogy of Fallot (TOF) repair depends on pulmonary valve annulus size and the z-score of pulmonary annulus is most commonly used as a predictor. The z-scores showed a weakness that it is ambiguous because of the use of varied z-score data sets.
Purpose
This study aimed to identify the echocardiographic and other key factors that warranted a change in the surgical method during TOF surgery.
Methods
Sixty two patients were enrolled and divided into a pulmonary valve (PV) preservation group and a TAP group. Their medical records were reviewed.
Results
The z-score for PV annulus (PVA), the ratio of the size of PVA to aortic annulus, and the ratio of the size of the PVA and descending aorta (DAO) were significantly different between PV preservation group and TAP group (-1.72±1.52 versus -3.07±1.94, P = 0.004, 0.62±0.12 versus 0.50±0.14, P = 0.002, 1.32±0.32 versus 1.07±0.36 and P = 0.008, respectively). For TAP repair, the PVA z-score was with a sensitivity of 65.4% and a specificity of 73.1%, the ratio of the size of PVA to aortic annulus with a sensitivity of 73.1% and a specificity of 65.4%, the ratio of the size of PVA to DAO with a sensitivity of 69.2% and a specificity of 57.7%. The TAP group showed more monocuspid PV (P = 0.011), and the PV preservation group showed more tricuspid PV (P = 0.027). Commissurotomy was more frequently performed in the PV preservation group than the TAP group (P = 0.001). Of patients with commissurotomy, 58% showed PV z score < -2.
Conclusion
Although various echocardiographic parameters may be used as predictors for determining the surgical method for TOF patients, the morphology and tissue characteristics of the PV should be also considered importantly.
Key Words: Echocardiography, Pulmonary valve, Surgery, Tetralogy of Fallot




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