Background: Pulmonary regurgitation is a frequent sequela after repair of Tetralogy of Fallot negatively affecting long-term prognosis and necessitating re-interventions.
The Shelhigh Injectable Stented Pulmonic Valve (SISPV) allows pulmonary valve replacement without cardiopulmonary bypass under direct control minimizing the impact of surgery on cardiac function.
Objective:The aim of the works is to describe our initial clinical experience with the intraoperative echocardiographic approach.
Methods: between April 2007 and December 2008, 5 symptomatic patients with severe pulmonary regurgitation and progressive right ventricular dysfunction after Tetralogy of Fallot repair received SISPV in our institution. All patients underwent trans-esophageal 2-D echocardiography during the surgical procedure.
Results: valve insertion, delivery, and placement were successful in all patients but one that required the repositioning of the same valve in cardiopulmonary by pass. Early recovery was uneventful and all the patients were discharged home after a mean length of hospital stay of 6.3±2.4 (2-12) days.
Intraoperatively, transesophageal echocardiography was the unique tool to guide device positioning and verify surgical results. In two patients echo documented a valve displacement after delivery and guided the repositioning (one in cardiopulmonary by-pass). In the immediate postoperative course serial echocardiographic examinations documented right ventricle reverse remodeling and excluded later complications.
Conclusion: Trans esophageal echocardiography plays a pivotal role in the intraoperative management of patients with significant pulmonary regurgitation after repair of Tetralogy of Fallot underwent pulmonary valve replacement with injectable valves.