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

Published online by Cambridge University Press:  01 December 2008

Guo-Wei He*
Affiliation:
TEDA International Cardiovascular Hospital, Nankai University, Tianjin, China Wuhan Heart Institute, The Central Hospital of Wuhan, Wuhan, China Department of Surgery, Starr Academic Center, St. Vincent Heart & Vascular Institute, Oregon Health and Science University, Portland, Oregon, United States of America Department of Surgery, The Chinese University of Hong Kong, Hong Kong
Xiao-Cheng Liu
Affiliation:
TEDA International Cardiovascular Hospital, Nankai University, Tianjin, China
Xiang-Rong Kong
Affiliation:
TEDA International Cardiovascular Hospital, Nankai University, Tianjin, China
Li-Xin Liu
Affiliation:
TEDA International Cardiovascular Hospital, Nankai University, Tianjin, China
Ying-Qun Yan
Affiliation:
TEDA International Cardiovascular Hospital, Nankai University, Tianjin, China
Bao-Jun Chen
Affiliation:
Wuhan Heart Institute, The Central Hospital of Wuhan, Wuhan, China
Zong-Xiao Li
Affiliation:
TEDA International Cardiovascular Hospital, Nankai University, Tianjin, China
Wen-Bin Jing
Affiliation:
TEDA International Cardiovascular Hospital, Nankai University, Tianjin, China
Zheng-Qing Wang
Affiliation:
TEDA International Cardiovascular Hospital, Nankai University, Tianjin, China
Kai Wang
Affiliation:
TEDA International Cardiovascular Hospital, Nankai University, Tianjin, China
Wei Zhang
Affiliation:
TEDA International Cardiovascular Hospital, Nankai University, Tianjin, China
Tie-Nan Chen
Affiliation:
TEDA International Cardiovascular Hospital, Nankai University, Tianjin, China
Ping-Shan Wang
Affiliation:
TEDA International Cardiovascular Hospital, Nankai University, Tianjin, China
Wan-li Lu
Affiliation:
TEDA International Cardiovascular Hospital, Nankai University, Tianjin, China
Jian-Liang Zhang
Affiliation:
TEDA International Cardiovascular Hospital, Nankai University, Tianjin, China
Zhi-Peng Guo
Affiliation:
TEDA International Cardiovascular Hospital, Nankai University, Tianjin, China
Lan-Gang Xue
Affiliation:
TEDA International Cardiovascular Hospital, Nankai University, Tianjin, China
Yu-Xiang Zhu
Affiliation:
TEDA International Cardiovascular Hospital, Nankai University, Tianjin, China
Xiu-Li Wang
Affiliation:
TEDA International Cardiovascular Hospital, Nankai University, Tianjin, China
Lei Xi
Affiliation:
TEDA International Cardiovascular Hospital, Nankai University, Tianjin, China
*
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

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.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2008

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Footnotes

*

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.

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