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Repair of tetralogy of Fallot with pulmonary atresia in early infancy

Published online by Cambridge University Press:  19 August 2008

Hideki Uemura ,
Toshikatsu Yagihara  and
Yasunaru Kawashima
Hideki Uemura*
Affiliation:
From the Department of Cardiovascular Surgery, National Cardiovascular Center, Suita, Osaka
Toshikatsu Yagihara
Affiliation:
From the Department of Cardiovascular Surgery, National Cardiovascular Center, Suita, Osaka
Yasunaru Kawashima
Affiliation:
From the Department of Cardiovascular Surgery, National Cardiovascular Center, Suita, Osaka
*
Dr. Hideki Uemura, Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565, Japan. Tel. 81-6-833-5012; Fax. 81-6-872-7486.
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Abstract

Believing early repair to offer major benefits, we have repaired tetralogy of Fallot with pulmonary atresia in five infants aged less than six months. The ventricular septal defect was closed via a right atriotomy. The right ventriculotomy was 30±3% of the right ventricular length. The posterior wall of the right ventricular outflow tract was created by anastomosing directly the pulmonary trunk to the right ventriculotomy, or either by interposition of the left atrial appendage or an autologous pericardia! flap. The pathway was then roofed over with an equine pericardia! patch. All patients survived and are now doing well from 18 to 41 (31±11) months after the repair, although one patient required reoperation for relief of stenosis at the site of an anastomosis between the pulmonary arteries and the interposed left appendage. In the other patients, postoperative sequential echocardiography has shown no obstruction in the right ventricular outflow tract, nor significant pulmonary or tricuspid regurgitation. We conclude that primary repair in early infancy is an excellent option for surgical treatment of tetralogy of Fallot with pulmonary atresia.

Keywords

Tetralogy of Fallot with pulmonary atresiarepair during infancyright ventricular outflow tract reconstruction
Type
Original Manuscripts
Information
Cardiology in the Young , Volume 5 , Issue 4 , October 1995 , pp. 326 - 330
Copyright
Copyright © Cambridge University Press 1995

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References

1. Graham, TPJ. Myocardial functional abnormalities in congenital heart disease: effects of cyanosis and abnormal loading conditions. In: Godman, J (ed). Paediatric Cardiology, Volume 4. Churchill Livingstone, Edinburgh, 1981, pp 103–116.Google Scholar
2. Deanfield, JE, McKenna, WJ, Presbitero, P, England, D, Graham, GR, Hallidie-Smith, K. Ventricular arrhythmia in unrepaired and repaired tetralogy of Fallot: relation to age, timing of repair, and haemodynamic status. Br HeartJ 1984; 52:77–81.Google Scholar
3. Borow, KM, Green, LH, Castaneda, AR, Keane, JF. Left ventricu lar function after repair of tetralogy of Fallot and its relationship to age at surgery. Circulation 1980; 61: 1150–1158.Google Scholar
4. Becker, AE, Anderson, RH. Cardiac pathology: complications of congenital heart disease. In: Berry, CL (ed). Paediatric Pathology, Second edition . Springer-Verlag, Berlin, 1989, pp 113–115.Google Scholar
5. Haworth, SG. Normal pulmonary vascular development and its disturbance in congenital heart disease. In: Godman, J (ed). Paediatric Cardiology, Volume 4. Churchill Livingstone, Edinburgh, 1981, pp 46–55.Google Scholar
6. Frescura, C, Thiene, G, Franceschini, E, Talenti, E, Mazzucco, A. Pulmonary vascular disease in infants with complete atrioventricular septal defect. IntJ Cardiol 1987; 15: 91–100.Google Scholar
7. Nakata, S, Imai, Y, Takanashi, Y, Kurosawa, H, Tezuka, K, Nakazawa, M, Ando, M, Takao, A. A new method for the quantitative standardization of cross-sectional areas of the pul monary arteries in congenital heart diseases with decreased pulmonary blood flow. J Thorac Cardiovasc Surg 1984; 88: 610–619.Google Scholar
8. Touati, GD, Vouhé, PR, Amodeo, A, Pouard, P, Mauriat, P, Leca, F, Neveux, JY. Primary repair of tetralogy of Fallot in infancy. J Thorac Cardiovasc Surg 1990; 99: 396–403.Google Scholar
9. Karl, TR, Sano, S, Pornviliwan, S, Mee, RBB. Tetralogy of Fallot: favorable outcome of nonneonatal transatrial, transpulmonary repair. Ann Thorac Surg 1992; 54: 903–907.Google Scholar
10. Castaneda, AR, Mayer, JEJ, Jonas, RA, Lock, JE, Wessel, DL, Hickey, PR. The neonate with critical congenital heart disease: repair: a surgical challenge. J Thorac Cardiovasc Surg 1989; 98: 869–875.Google Scholar
11. DiDonato, RM, Jonas, RA, Lang, P, Rome, JJ, Mayer, JEJ, Castaneda, AR. Neonatal repair of tetralogy of Fallot with and without pulmonary atresia. J Thorac Cardiovasc Surg 1991; 101: 126–137.Google Scholar
12. Kirklin, JW, Barratt-Boyes, BG. Complete transposition of the great arteries. In: Kirklin, JW, Barratt-Boyes, BG (eds). Cardiac Surgery, Second edition, Volume 2. Churchill Livingstone, New York, 1993, pp 1436–1438.Google Scholar
13. Barbero-Marcial, M, Riso, A, Atik, E, Jatene, A. A technique for correction of truncus arteriosus types I and II without extracardiac conduits. J Thorac Cardiovasc Surgery 1990; 99: 364–369.Google Scholar
14. Naito, Y, Fujita, T, Tomino, T, Tanaka, K, Koh, Y, Isobe, F, Hayashi, K, Yamada, O, Hirose, O, Kamiya, T, Manabe, H. Total correction of tetralogy of Fallot: operative results, surgi cal indication, operative procedure and postoperative manage ment. Nippon Kyobu Geka Gakkai Zasshi 1982; 30: 200–206. [Japanese]Google Scholar
15. Kishimoto, H, Hirose, H, Nakano, S, Matsuda, H, Shimazaki, Y, Kobayashi, J, Ogawa, M, Morimoto, S, Arisawa, J, Kawashima, Y. Angiographic determination of right and left ventricular vol umes and diameter of atrioventricular and semilunar valve rings in normal subjects. Shinzo 1985; 17: 711–716. [Japanese]Google Scholar
16. Tamisier, D, Vouhe, PR, Vernant, F, Leca, F, Massot, C, Neveux, JY. Modified Blalock-Taussig shunts: results in infants less than 3 months of age. Ann Thorac Surg 1990; 49: 797–801.Google Scholar
17. Hennein, HA, Mosca, RS, Urcelay, G, Crowley, DC, Bove, EL. Intermediate results after complete repair of tetralogy of Fallot in neonates. J Thorac Cardiovasc Surg 1995; 109: 332–344.Google Scholar