Recycling of the Pulmonary Valve: An Elegant Solution for Secondary Pulmonary Regurgitation in Patients With Tetralogy of Fallot

Background The purpose of this study was to review our experience with recycling of the pulmonary valve in cases of chronic pulmonary insufficiency after a transannular patch procedure as part of a repair of tetralogy of Fallot. Methods Eight patients in whom the technique was used were reviewed. Technically, the valve was reapproximated at the anterior commissure if the valve leaflet was sufficiently developed and of good tissue quality. Additional corrections were performed in 5 patients (resection of an infundibular aneurysm [5 patients], repair of the tricuspid valve [1 patient]). Results The valve was competent with no or trivial regurgitation in 5 patients and a small regurgitation in 3 patients. There was no significant transvalvular gradient in 5 patients with tricuspid valves and a small gradient in 3 patients with a bicuspid valves (< 23 mm Hg). The valve function remained stable over the follow-up period (median time, 32 months). Conclusions Recycling of the pulmonary valve is an interesting concept that could avoid the necessary reoperations linked with valves or valved prostheses. The repair must be carefully followed in bicuspid valves because of a reduction in the opening area. Valve leaflets of good quality should be preserved during the primary repair of tetralogy of Fallot and the transannular incision should be made across the anterior commissure if possible. These steps should allow a few patients to profit from a recycling of their valves in the future.