The balloon dilation of the pulmonary valve during early repair of tetralogy of Fallot.

BACKGROUND AND OBJECTIVE: Progressive pulmonary valve (PV) regurgitation leads to right ventricular failure after repair of tetralogy of Fallot (TOF). We sought to evaluate our results with the preservation of the PV in selected patients with TOF. METHODS: All patients with TOF who were scheduled for PV's preservation between June 2007 and May 2010 were enrolled. Surgical correction involved the combination of early transatrial repair and intraoperative balloon dilation of the PV annulus. RESULTS: Of 18 patients, 16 (89%) underwent a successful preservation of the PV. Median age at surgery was 3.1 months (range 2.4-4.7 months). Median preoperative PV Z-score was -2.5 (range -1.4 to -3.12) and the median peak right ventricle outflow tract (RVOT) gradient was 80 mm Hg (range 49-90 mm Hg). No procedure-related complications were reported. The size of the PV annulus after the balloon dilation was appropriate for body surface area in all patients. Median follow-up time was 1.4 years (range 0.5-3.3 years). Reoperation was needed in one patient 3 months after repair because of residual subvalvar RVOT obstruction. The remaining 15 patients are alive and well. The median PV Z-score is 0 (range -0.2 to 1). Median peak RVOT gradient is 20 mm Hg (range 12-32 mm Hg). The PV is competent in seven patients; mild PV regurgitation is present in seven patients and moderate in one. CONCLUSIONS: The integrity of the PV annulus and PV function can be preserved in selected patients during early repair of TOF when using concomitant balloon dilation. The PV preservation will hopefully prevent long-standing RV dysfunction.