Abstract
Tetralogy of Fallot (ToF) is one of the most studied congenital heart diseases, but despite this, discussions are still underway about the choice of the optimal method of surgical correction for this pathology. Currently, transannular plasic (TAP) ratio is changing, which is reflected in the many centers trend to reduce the frequency of its use. Despite this, TAP is used in more than half of all cases of correction for ToF. The European Association of Cardiothoracic Surgery database analysis, in which more than 6.5 thousand ToF operations were analyzed, showed that TAP was performed in 60% of cases with ventriculotomy combination. Thus, in more than 50% of all ToF correction its result in a decrease in the pulmonary valve functionality.
To preserve the function of the right ventricle (RV) in the long term, as well as to reduce the risk of repeated interventions, surgical correction of ToF should be performed with the preservation of the native valve or simultaneous surgery of the pulmonary valve with the restoration of its coaptation functionality. Given the significant increase in survival after ToF correction in recent decades, complications presence arising in the long-term period and severe pulmonary regurgitation and right ventricular failure have become much more common. Timely pulmonary valve restoration stops the progressive RV remodeling, leading to its dysfunction. Understanding the complications pathophysiology processes is necessary for the formation of adequate surgical tactics in patients with this pathology, to which this review is largely devoted.
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About the authors
- Aleksey I. Kim, Dr. Med. Sci., Professor, Head of Department of Cardiac Surgery of Newborns and Infants; ORCID
- Tigran R. Grigoryants, Cand. Med. Sci., Leading Researcher, Cardiovascular Surgeon; ORCID
- Olga Yu. Timofeeva, Postgraduate, Cardiovascular Surgeon; ORCID
