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The current strategy of repair of tetralogy of Fallot in children and adults*

  • Guo-Wei He (a1) (a2) (a3) (a4), Xiao-Cheng Liu (a1), Xiang-Rong Kong (a1), Li-Xin Liu (a1), Ying-Qun Yan (a1), Bao-Jun Chen (a2), Zong-Xiao Li (a1), Wen-Bin Jing (a1), Zheng-Qing Wang (a1), Kai Wang (a1), Wei Zhang (a1), Tie-Nan Chen (a1), Ping-Shan Wang (a1), Wan-li Lu (a1), Jian-Liang Zhang (a1), Zhi-Peng Guo (a1), Lan-Gang Xue (a1), Yu-Xiang Zhu (a1), Xiu-Li Wang (a1) and Lei Xi (a1)...

Abstract

Objectives

The strategies of repair of tetralogy of Fallot change with the age of patients. In children older than 4 years and adults, the optimal strategy may be to use different method of reconstruction of the right ventricular outflow tract from those followed in younger children, so as to avoid, or reduce, the pulmonary insufficiency that is increasingly known to compromise right ventricular function.

Methods

From April, 2001, through May, 2008, we undertook complete repair in 312 patients, 180 male and 132 female, with a mean age of 11.3 years ±0.4 years, and a range from 4 to 48 years, with typical clinical and morphological features of tetralogy of Fallot, including 42 patients with the ventriculo-arterial connection of double outlet right ventricle. The operation was performed under moderate hypothermia using blood cardioplegia. The ventricular septal defect was closed with a Dacron patch. When it was considered necessary to resect the musculature within the right ventricular outflow tract, or perform pulmonary valvotomy, we sought to preserve the function of the pulmonary valve by protecting as far as possible the native leaflets, or creating a folded monocusp of autologous pericardium.

Results

The repair was achieved completely through right atrium in 192, through the right ventricular outflow tract in 83, and through the right atrium, the outflow tract, and the pulmonary trunk in 36 patients. A transjunctional patch was inserted in 169 patients, non-valved in all but 9. There were no differences regarding the periods of aortic cross-clamping or cardiopulmonary bypass. Of the patients, 5 died (1.6%), with no influence noted for the transjunctional patch. Of those having a non-valved patch inserted, three-tenths had pulmonary regurgitation of various degree, while those having a valved patch had minimal pulmonary insufficiency and good right ventricular function postoperatively, this being maintained after follow-up of 8 to 24-months.

Conclusions

Based on our experience, we suggest that the current strategy of repair of tetralogy of Fallot in older children and adults should be based on minimizing the insertion of transjunctional patches, this being indicated only in those with very small ventriculo-pulmonary junctions. If such a patch is necessary, then steps should be taken to preserve the function of the pulmonary valve.

Copyright

Corresponding author

Correspondence to: Professor Guo-Wei He, MD, PhD, DSc., Senior Cardiac Surgeon, Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, 61, Third Avenue, TEDA, Tianjin, China, Post code: 300457. Tel: (Hong Kong ) – (852) 2645 0519; Fax: (852) 2645 1762; E-mail: gwhe@cuhk.edu.hk

Footnotes

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*

The presentation on which this work is based was given at the Inaugural Meeting of the World Society for Pediatric and Congenital Heart Surgery, held in Washington, District of Columbia, May 3 and 4, 2007.

Footnotes

References

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Cardiology in the Young
  • ISSN: 1047-9511
  • EISSN: 1467-1107
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