Clinical performance of the native pulmonary valve in the systemic circulation

Background and aim of the study: In a number of corrective and palliative p rocedures the autologous pulmonary valve is used as the systemic semilunar valve. This study reviews the surgical results and function of the native p ulmonary valve in the systemic position after various surgical procedures. Methods: Between January 1994 and December 1997, the autologous pulmonary v alve was transferred functionally or anatomically into the systemic circula tion in 89 patients. Follow up echocardiograms and cardiac angiograms were reviewed for 51 neonates with transposition of the great arteries after an arterial switch operation (ASO), in 21 patients after first-stage palliatio n of hypoplastic left heart syndrome (HLHS), in eight children and adults w ith pulmonary autograft aortic valve replacement (Ross procedure), and in n ine patients with a pulmonary artery-to-aortic anastomosis (Damus-Kaye-Stan sel (DKS) procedure) in complex heart defects with outflow obstruction. Results: Nine patients (five with HLHS) died; thus, overall mortality rate was 10.2%. There was no evidence of valve-related mortality. Trivial insuff iciency following ASO was noted in 11 patients, with no progression of inco mpetence over time. None of the HLHS patients had pulmonary insufficiency p reoperatively, but all showed mild regurgitation on postoperative echocardi ography. There was a moderate increase in insufficiency which was attenuate d after an early second-stage palliation. Three of nine patients undergoing a DKS anastomosis demonstrated a hemodynamically insignificant insufficien cy. Modification of the surgical technique avoided postoperative regurgitat ion. Four of seven patients having a Ross procedure showed trivial but non- progressive neoaortic regurgitation. Conclusions: Based on this experience, the autologous pulmonary valve perfo rms adequately at intermediate term follow up. Postoperatively, trivial reg urgitation was a frequent finding but was hemodynamically insignificant. Pr ogression or late development of insufficiency as well as stenosis were rar e problems.