Akram Allam
Alexandria University, Egypt
Title: Fate of right ventricle outflow gradient after fallot repair
Biography
Biography: Akram Allam
Abstract
Objective: This study was done to evaluate the effect of residual gradient on early mortality and follow up the fate of this gradient. Methods: Between December 2011 and 2013, 43 patients with Fallot tetralogy operated upon in Cardiothoracic Surgery Department, Alexandria University were reviewed, direct intraoperative measured gradient and the echo-gradient were recorded and pressure ratio between right and left ventricle. The residual gradient was considered significant if it exceeds 40 mmHg or pressure ratio exceeds 0.85, transannular patch was used in 17 patients. Clinical and echo data were assessed over the study and time and every 3 months after discharge. Results: Median age was 4.2 years (8 months – 37 years), there was 6 early deaths (13.95%) all of them not related to high outflow gradient 23 patients (53.48%) had gradient higher than 40 mmHg, one of them with fixed obstruction and gradient of 60 mmHg and is scheduled for revision. On follow-up echo. There was a significant fall in right ventricular outflow gradient on predischarge echocardiograms (47 + 16.8 to 31.5 + 14.7 mmHg p < 0.005). A further significant fall in gradients was noticed at a mean follow-up of 5 + 3 months (20 + 9 mmHg, p < 0.05). Conclusions: This study showed that in patients with dynamic obstruction, there was a significant reduction in residual outflow gradient, and immediate revision was not needed. Echo is essential in identifying dynamic from fixed obstruction in addition to the surgeon belief of the adequacy of the outflow