Title: Feasibility of transatrial-transpulmonary total correction of TOF
Authors: Dr Nasir U Din Wani, Dr Syed Abir Hussain, Dr Tasneem Muzaffar, Dr Abdul Gani Ahangar, Dr Ghulam Nabi Lone
DOI: https://dx.doi.org/10.18535/jmscr/v7i4.06
Abstract
Background: Right ventricular (RV) dysfunction is a significant cause of morbidity and mortality after surgical correction of tetralogy of Fallot (TOF). Transatrial-transpulmonary repair avoids a ventriculotomy (in contrast to the transventricular approach) emphasizing maximal preservation of RV structure and function.
Methods: Between January 2005 to January 2014, 41 patients with TOF were referred to our unit for surgical therapy. Of these, 10 were unsuitable for repair and underwent aortopulmonary shunting. In the remaining 31 patients (mean age of 2.67±0.38 years), complete transatrial/transpulmonary repair was performed. Previously placed shunts (four patients) were taken down. In all cases, subpulmonary resection and ventricular septal defect (VSD) closure were accomplished transatrially and transpulmonary.
Results: There were 3 (9.67%) deaths in this series. No patient required permanent pacemaker. Median ICU and hospital stay were 91 hours and 14 days, respectively. At median follow up of 54 (mean 51±12) months, all patients are asymptomatic, with no significant residual lesion.
Conclusions: Transatrial/transpulmonary repair of TOF is associated with remarkably low morbidity and mortality in our early experience.
Keywords: Mortality, Morbidity, Tetralogy of fallot, Transatrial- transpulmonary repair.
References
- Anderson RH, Weinberg PM. The clinical anatomy of tetralogy of fallot. Cardiol Young. 2005;15 Suppl 1:38-47.
- Blalock A, Taussig HB. The surgical treatment of malformations of the heart in which there is pulmonary stenosis or pulmonary atresia. J Am Med Assoc. 1945;128:189-92.
- Lillehei CW, Coehn M, Warden HE, Red RC, Aust JB, De Wall RA, et al. Direct vision intracardiac surgical correction of the Tetralogy of Fallot, Pentalogy of Fallot and pulmonary atresia defects. Report of first 10 cases. Ann Surg. 1955;142 (3): 418-42.
- Edmunds Jr LH, Saxena NG, Friedman S, Raskind WJ, Dodd PF. Transatrial repair of tetralogy of Fallot. Surg. 1976;80: 681-8.
- Pacifico AD, Sand ME, Bargeron LM, Calvin EC. Transatrial transpulmonary repair of tetralogy of Fallot. J Thorac Cardiovasc Surg. 1987;93:919-24.
- Rowlatt JF, Rimoldi HJ, Lev M. The quantitative anatomy of the normal child's heart, Pediatr Clin North Am. 1963;10:499-588.