Does intraoperative transesophageal echocardiography predict pulmonary valve dysfunction during the Ross procedure?
J Cardiothorac Vasc Anesth
; 16(4): 437-40, 2002 Aug.
Article
em En
| MEDLINE
| ID: mdl-12154421
ABSTRACT
OBJECTIVE:
To determine the value of intraoperative transesophageal echocardiography for the assessment of the pulmonary valve anatomy and the pulmonary autograft performance in patients undergoing the Ross procedure.DESIGN:
Open, prospective, observational survey.SETTING:
Favaloro Foundation, single institution.PARTICIPANTS:
Consecutive patients undergoing elective Ross procedure (n = 87).INTERVENTIONS:
Pulmonary valve function and anatomy were assessed by transesophageal echocardiography and the surgeon. Pulmonary autograft function was assessed after implantation. Regurgitation was considered mild (+/4), moderate (++/4), moderate-to-severe (+++/4), and severe (++++/4). Patients were restudied during midterm follow-up. MEASUREMENTS AND MAINRESULTS:
The Ross procedure was done in 74 patients (85%). Overall mortality was 3.4%. Mean follow-up was 24 +/- 13 months. The Ross procedure was not done in 13 patients (15%) 6 patients had a bicuspid pulmonary valve, 6 patients had >3 mm fenestrations, and 1 patient had regurgitation. The surgeon diagnosed anomalies in the pulmonary valve through direct observation. Transesophageal echocardiography was not sensitive enough to diagnose pulmonary valve defects in 12 of 13 patients with anomalies. Pulmonary valve regurgitation was identified by intraoperative transesophageal echocardiography in only 1 patient. Autograft regurgitation was 1.07 +/- 0.35 at postoperative evaluation. At 1, 6, and 12 months, it was 1.25 +/- 0.7 (p = 0.18), 1.27 +/- 0.9 (p = 0.185), and 1.29 +/- 0.8 (p = 0.17). The difference in values was not statistically significant. Four patients (5.4%) showed an increase in regurgitation during the first transthoracic autograft control.CONCLUSION:
Intraoperative transesophageal echocardiography allows assessment of autograft performance after implantation. This method is not helpful, however, in detecting pulmonary valve anatomic anomalies.
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Base de dados:
MEDLINE
Assunto principal:
Valva Aórtica
/
Artéria Pulmonar
/
Insuficiência da Valva Pulmonar
/
Ecocardiografia Transesofagiana
/
Cuidados Intraoperatórios
Tipo de estudo:
Diagnostic_studies
/
Evaluation_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
/
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Ano de publicação:
2002
Tipo de documento:
Article