**3. Surgical options for pulmonary valve pathology**

## **3.1 Open (surgical) pulmonary valvotomy**

Although transcatheter pulmonary balloon valvuloplasty is becoming a gold standard for isolated congenital pulmonary valve stenosis, surgical (open) pulmonary valvotomy may be required in some cases that are most commonly associated with pulmonary annular hypoplasia (**Figure 1**). The advantage of the open technique is the ability to relief the right ventricular outflow tract (RVOT) obstruction in a controlled fashion *via* splitting the commissures of the pulmonary valve without causing significant regurgitation. It is also useful in addressing associated pulmonary annular hypoplasia *via* the use of a concomitant transannular patch with *Surgical Options for Pulmonary Valve Pathology in the Current Era DOI: http://dx.doi.org/10.5772/intechopen.100297*

### **Figure 1.**

*Intraoperative photo in an infant with isolated congenital pulmonary valve stenosis and hypoplastic pulmonary annulus. Notice the classic bicuspid pulmonary valve with fused commissures. RV: right ventricle; PA: pulmonary artery.*

or without reconstruction of a monocusp leaflet. This technique is reported to have long-term excellent results in selected patients [1].

### **3.2 Pulmonary valve repair**

Pulmonary valve repair is possible in selected congenital or acquired cases of pulmonary regurgitation. In the patients who underwent repair of tetralogy of Fallot (TOF) *via* a transannular patch with preservation of the native pulmonary leaflets and present later with dilated pulmonary artery and free pulmonary regurgitation, it is possible to remove the part of the transannular patch and bring the remaining leaflets together anteriorly thus reconstructing the anterior commissure and creating a bicuspid pulmonary valve [2]. In a previous report of 13 patients who underwent TOF repair using a transannular patch and present for pulmonary valve replacement (PVR), it was possible to avoid a prosthesis by repairing the pulmonary valve according to the technique described above [2]. The degree of regurgitation was markedly decreased in all patients and continued during the follow-up period. It is also possible to create a new leaflet from the autologous or bovine pericardium to form a tricuspid pulmonary valve if the other remaining two leaflets are of good quality thus avoiding the use of a prosthesis/homograft.

### **3.3 Pulmonary valve replacement**

Although most valve procedures performed annually involve the aortic and/or mitral valves, the need for pulmonary valve replacement (PVR) is increasing due to the increase in patients with congenital heart disease who survive to adulthood. Because of the improved postoperative care and long-term survival of children undergoing repair of congenital heart defects, it is reasonable to predict that the problem of young adults who have developed sequelae of pulmonary regurgitation after repair of tetralogy of Fallot or neonatal/infant interventions for pulmonary stenosis or atresia will be seen with increasing frequency. In general, most authors recommend the use of bioprostheses or homografts for PVR in children and young adults [3].

A wide variety of materials have been utilized for PVR and or reconstruction of the RVOT. The most commonly used materials include autologous or bovine

pericardium, bioprosthetic (bovine or porcine) or mechanical valves, Dacron conduits/grafts, bovine jugular veins, and homograft (aortic and pulmonary).
