MECHANICAL VALVES IN THE PULMONARY POSITION - A REAPPRAISAL

Objectives: To evaluate midterm results of mechanical valves in pulmon ary position in patients with pulmonary regurgitation and right ventri cular dysfunction as an alternative to bioprostheses. Patients: Mechan ical valves (six tilting disc valves and two bileaflet valves) were im planted in eight patients previously operated on for tetralogy of Fall ot (n = 7) and truncus arteriosus (n = 1), with severe right ventricul ar dysfunction caused by massive pulmonary regurgitation, Results: All patients survived prosthesis implantation and are currently well, At follow-up (3 months to 9 years), they do not show signs of valve failu re, and right ventricular function has dramatically improved in all bu t one, who still shows moderate ventricular hypokinesia, Conclusion: A fter operative correction of congenital heart defects in selected pati ents who show severe dysfunction of the right ventricle caused by pulm onary regurgitation/stenosis, mechanical valves may represent an alter native to bioprosthetic valves. The selection of the valve type is sti ll a matter of debate, However, according to literature data, complica tions seem to have occurred only in patients with bileaflet mechanical valves in the pulmonary position, whereas no thromboembolic episodes or valve failure is reported in subjects with tilting disc valves in t he right ventricular outflow, Tilting disc valves might perform better in the right ventricular outflow than bileaflet valves.