Transatrial-transpulmonary repair of tetralogy of Fallot

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 93; no. 6; pp. 919 - 924
• Main Authors: Pacifico, AD, Sand, ME, Bargeron, LM, Jr, Colvin, EC
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA AATS/WTSA 01.06.1987; Elsevier
• Subjects: Biological and medical sciences; Cardiology. Vascular system; Child, Preschool; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Follow-Up Studies; Heart; Humans; Infant; Medical sciences; Postoperative Complications; Radiography; Tetralogy of Fallot - diagnostic imaging; Tetralogy of Fallot - surgery; Human; Atrium; Corrective surgery; Prognosis; Congenital; Cardiovascular disease; Infant; Pulmonary artery; Heart disease; Fallot tetralogy; Adult; Surgical approach; Child
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/s0022-5223(19)37053-9

Classical tetralogy of Fallot was repaired by a transatrial-transpulmonary approach in 61 of 70 patients treated surgically on one surgical service between July 1981 and December 1985. Their ages ranged from 2.5 months to 57 years (mean 52.9 +/- 104.2 months). The ventricular septal defect was closed through the right atrium and tricuspid valve in 60 patients and via the pulmonary artery in one patient with a subpulmonary defect. A pulmonary arteriotomy was made in 38 patients to expose the stenotic pulmonary valve for valvotomy and to begin the infundibular mobilization and resection. It was extended through a small pulmonary anulus primarily in 15 patients and secondarily in one, a minimal distance upon the right ventricular infundibulum to enlarge the outflow tract to 2 standard deviations larger than the mean normal pulmonary valve anulus diameter. There were no hospital or late deaths or reoperations among the entire group. The mean postrepair peak right ventricular/left ventricular pressure measured in the operating room was 0.52 +/- 0.165 for the entire group of 61 patients which indicates similar relief of pulmonary stenosis to that obtained by the classical transventricular repair. At follow-up between 2.3 and 53.8 months (mean 22.6) each patient was in New York Heart Association Class I and without cardiac medication. Postoperative cardiac catheterization studies performed in nine patients between 4 and 28 months after operation showed no residual ventricular septal defects and a mean peak right/left ventricular pressure of 0.42 +/- 0.13. This series indicates that successful repair of tetralogy of Fallot can be accomplished in most patients by a transatrial-transpulmonary approach, which may provide improved right ventricular function over the long term.