Summary
In 6 children under 2 years of age correction of congenital heart defects required
reconstruction of the right ventricular outflow tract including replacement of the
pulmonary valve. Outflow tract reconstruction consisted in implantation of a size
14 valved conduit in 2 patients with d-TGA and subpulmonary stenosis and 1–TGA and
subpulmonary stenosis, and a size 16 valved conduit in 2 other patients with truncus
arteriosus. In 2 children with DOLV, VSD and aneurysm of the pulmonary artery trunk,
the pulmonary valve was replaced by porcine heterografts, sizes 19 and 21 respectively,
after primary patch reconstruction of the right ventricular outflow tract. There was
one operative death in a child with d-TGA, intact ventricular septum and severe subpulmonary
stenosis. This child died in low cardiac output, probably because too much contractile
muscle was lost at the site of anastomosis with the conduit. For reconstruction of
the right ventricular outflow tract, pulmonary valve replacement has proven mandatory
in cases with pulmonary hypertension in order to prevent postoperative right heart
failure. Similarly, in cases with pulmonary stenosis and hypoplastic pulmonary arteries,
postoperative pulmonary insufficiency can be deleterious to the right ventricle.
Key-Words:
Pulmonary valve replacement - Conduit - Pulmonary hypertension - Right heart failure
