Link : https://youtu.be/y7c6qrCNmHQ
Discussion
There have been numerous attempts to establish useful prognostic
indicators for congenital heart disease. Some indices that have shown
good prognostic value include the McGoon ratio, Nakata index, pulmonary
arterial index, and TNPAI. More recently, the PVI has been indicated as
a predictor for early outcomes during the surgical treatment of patients
with TOF. In this study, we determine the predictive value of PVI. Yuan
et al, in their study, indicated that a reduced PVI is a significant
risk factor for early death and prolonged postoperative recovery. They
estimated the cut-off point of PVI at 300.3 mm2/m2. In our case, PVI is
368.12 mm2/m2, which resulted in a smoother and uneventful postoperative
recovery.
Pulmonary blood flow has a major effect on the prognosis of patients
with CHDs, and PA parameters, such as the McGoon ratio and Nakata index,
are the most commonly used parameters for the evaluation of pulmonary
blood flow and as prognostic indicators for the successful surgical
repair of TOF. However, it has been shown that PVI provides a more
accurate indicator of pulmonary blood flow than that of the PAs.
Another objective of this case report was to assess the performance of
PTFE-MVs. Construction of the PTFE-MV is an inexpensive and
straightforward way to create a competent RVOT in a variety of RVOTO
anomalies
[16,17].
Moreover, reports show that PTFE-MVs appeared equal or superior to
biologic monocusp valves, providing perioperative RVOT competence and
improved right ventricular functional characteristics, reduced ICU stay,
and decreased operative morbidity and mortality in patients with TOF
[17].
Although the literature has been inconclusive regarding the
perioperative function and clinical benefit of PTFE-MV for RVOT
reconstruction, PTFE-MV has proven to be a simple and reproducible
technique demonstrating excellent early postoperative function with
minimal pulmonary insufficiency
[18].
All types of monocusps have shown, particularly in the immediate
postoperative period, to significantly reduce or prevent pulmonary
insufficiency. The elimination of pulmonary insufficiency is associated
with faster recovery of RV function, a lower central venous pressure,
and less postoperative chest tube drainage
[19].
A review of 196 patients demonstrated only mild to moderate
insufficiency in 58% of patients at 10 years, and no significant RVOT
stenosis. In our study, we show that PVI with PTFE-MV reconstruction for
RVOT is a valuable preoperative predictor for early prognosis in TOF.
The patient in our case report underwent a detailed cardiological
evaluation with electrocardiogram, 2D echocardiography, and cardiac CT
dynamic study. Cardiac CT is a noninvasive technique that offers several
approaches to establish the hemodynamic severity of coronary artery
obstructions, demonstrates a good correlation with directly measured
coronary flow and fractional flow reserve
[20],
and provides incremental diagnostic value over coronary CT angiography
alone for the identification of hemodynamically significant coronary
artery disease
[21].
Conclusions
In this case report, we determine how the PVI will impact the
postoperative outcome of surgically treated patients with TOF, and
whether we can correlate the indices and postoperative recovery. The
other aspect of the study is the performance of PTFE-MV. The PTFE-MV
does not calcify in the membrane but rather a well-vascularized layer of
nonobstructive fibrocollagenous tissue is incorporated within the PTFE
with focal areas of endothelialization. Thus, the PTFE-MV integrates
with the RVOT patch to a variable degree.
Reconstruction of the RVOT with a PTFE MO valve has proven to be a
simple and reproducible technique demonstrating excellent early
postoperative function with minimal PR. Moreover, there is a degree of
early clinical benefit in patients reconstructed with a PTFE-MV when
compared with TAP repairs. Hence, PVI with PTFE-MV for RVOT
reconstruction is a valuable preoperative predictor for early prognosis
of patients with TOF. In addition, cardiac CT dynamic study is a
valuable tool recommended as it is a noninvasive technique that can
pin-point the morphology of extra-cardiac vessels.
ACKNOWLEDGEMENTS –
We are thankful to –
Mr. Naresh Jayantibhai Fumakiya, Echo-Cardiographer, Bhanubhai and
Madhuben Patel Cardiac Centre, Shree Krishna Hospital, Karamsad.
Mr. Khushal N. Vankar, Office Assistant, Department of Diagnostic
Services, Shree Krishna Hospital, Bhaikaka University, Karamsad.Email : khushalnv@charutarhealth.org
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