日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

To review the recent circumstances for surgical pulmonary valve replacement (PVR) in the United Kingdom, we summarized the clinical data from three different levels: 1) statistics in the National Database, 2) experience at a major adult congenital heart center, and 3) experience of a surgeon at the institution.

1) The number of patients who underwent PVR markedly increased during the last decade, and the sum total was 25% of the 7,028 surgical cases with adult congenital heart disease that were registered in the database.

2) The institution had 393 patients of PVR, including 242 with repaired tetralogy of Fallot and 78 after pulmonary stenosis relief. For the valves, a bioprosthesis was used in 227 patients, a homograft was used in 133, and a conduit bearing a bioprosthesis in 33.

3) The surgeon preferred to use a bioprosthesis in 109 of his 117 patients. The pre-PVR cardiothoracic ratio was smaller in 31 patients in whom the pulmonary valvular hinge had been preserved (p=0.009) than in those who had a trans-annular incision. Concomitantly with PVR, a tricuspid valve procedure was performed in 29 patients, surgical anti-arrhythmic procedure in 13, and an enlargement of the proximal right/left pulmonary artery in 11. The PVR maneuver was performed with a beating heart in 88 patients. Femoral cannulation was required in 8. Two patients died early due to severe right heart failure or sudden ventricular arrhythmia. In the longer term follow-up, no further deaths were noted. Two patients required re-operation. A degree of scoliosis was observed in 30 patients.

This review illustrates the current status of PVR practice in the UK.