Key result
Right atrial appendage pulmonary valve creation yields ~4.5-mm annulus growth with low gradients at follow-up.
Why the study?
Pulmonary stenosis has been reported by some groups following pulmonary valve creation from a patient's right atrial appendage, prompting the evaluation of positioning the harvested right atrial appendage over an appropriate Kirklin size Hegar dilator for stenosis prevention.
Does pulmonary valve creation using a harvested right atrial appendage positioned over an appropriate Kirklin size Hegar dilator prevent pulmonary stenosis and allow annular growth in pediatric patients?
Cohort (n=20)
No
Does pulmonary valve creation using a harvested right atrial appendage positioned over an appropriate Kirklin size Hegar dilator prevent pulmonary stenosis and allow annular growth in pediatric patients?
Creating a pulmonary valve from the right atrial appendage over an appropriately sized Kirklin Hegar dilator allows appropriate annular growth and prevents medium-term stenosis, though regurgitation develops in about half of patients.
Answers are grounded in this paper and cite their sources.
Hypothesis-generating for autologous right atrial appendage valves; prospective trials needed before any practice consideration.
Objective The technique of pulmonary valve creation from a patient’s right atrial appendage is being used by a number of centres. Pulmonary stenosis has been reported by some groups. We created the initial pulmonary valve with the harvested right atrial appendage positioned over the appropriate kirklin size hagar dilator for stenosis prevention. Methods We reviewed the outcome for our first consecutive 20 patients with a mean of 2.7 years of follow-up. 15 patients underwent a focused detailed pulmonary valve echo at latest follow-up. Results are mean+/-standard deviation. Results Mean age at repair was 8.8 months and 75% had Fallot’s Tetralogy. The mean pulmonary valve annulus diameter growth from initial post-op echo to a mean of 2.7 years later was 9.9+/-1.7mm to 14.4+/-3.3mm, P<0.05, with predicted Kirklin size of 14.4+/0.8mm. The mean post-op pulmonary valve gradient of 16+/-9mmHg remained low on echo 2.7 years later at 12+/-4mmHg, P=0.08. The 15 patients with a focussed pulmonary valve echo all had trace/mild regurgitation after their initial surgery, and after mean 2.7 years approx. ½ still had trace/mild regurgitation. Conclusions Pulmonary valve creation using an appropriately sized dilator positioned through the harvested right atrial appendage prevents medium-term stenosis, but hypothesized disproportionate leaflet growth leads to regurgitation in some patients.
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McGuinness et al. (2026) conducted a cohort in Congenital heart disease requiring pulmonary valve creation (75% Tetralogy of Fallot) (n=20). Pulmonary valve creation from harvested right atrial appendage positioned over an appropriate Kirklin size Hegar dilator was evaluated on Mean pulmonary valve annulus diameter growth at mean 2.7 years follow-up (p=<0.05). Right atrial appendage pulmonary valve creation over a Kirklin-sized dilator increased mean annulus diameter from 9.9 to 14.4 mm (P<0.05) with low gradients (12 mmHg) at 2.7 years.
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