Reoperations for Obstructed Ventriculopulmonary Conduits

Abstract

Between January 1977 and December 1986, 28 patients (11.8 ± 7 years old) underwent 31 reoperations for obstructed right ventriculopulmonary arterial conduits, 56.1 ± 30.8 months after the definitve repair of a congenital heart malformation in which 25 valved conduits, three all: grafts, and three non-valved conduits had been used. Obstruction resulted from isolated valvular degeneration (n = 14), isolated neo-intimal peel formation (n = 6), or a combination (n = 5); stenosis of distal pulmonary arterial anastomoses was present in two cases, and proximal right ventricular anastomoses in three cases. The mean transconduit pressure gradient decreased from 81 mmHg preoperatively to 20 mmHg postoperatively. During operation the first conduit was replaced with valved (n = 8) or nonvalved (n = 23) protheses; concomitant cardiac valve replacement was performed in two patients, and residual ventricular septal defect closure was achieved in ten patients. The were two hospital deaths (6.6%) and two late deaths (7.6%) related to the course of severe right ventricular failure. Cumulative follow-up was 106 patient years; follow-up at 3.8 ± 2.4 years (range 9–11 months) showed that all patients were in NYHA functional class I (n = 19) or class II (n = 2), except three patients (class III) with right ventricular failure. Close follow-up of patients with right pulmonary outflow tract reconstruction is necessary in order to be able to carry out reoperation for obstruction before severe right ventricular failure occurs.