Early results after transatrial repair of RVOT obstruction including teratology of fallot

Authors

  • Nasir u din Wani Department of CVTS, GMC, Srinagar, Jammu Kashmir, India
  • Tasneem Muzaffar Department of CVTS, GMC, Srinagar, Jammu Kashmir, India
  • Abdul Gani Ahangar Department of CVTS, SKIMS, Soura, Jammu Kashmir, India
  • Mir Mudasir Sidiq Department of CVTS, SKIMS, Soura, Jammu Kashmir, India
  • Ghulam Nabi Lone Department of CVTS, SKIMS, Soura, Jammu Kashmir, India
  • Abdul Majeed Dar Department of CVTS, SKIMS, Soura, Jammu Kashmir, India
  • Aadil Mohammed Lanker Department of Paediatrics, SKIMS, Soura, Jammu Kashmir, India
  • Mohammad Akbar Bhat Department of CVTS, SKIMS, Soura, Jammu Kashmir, India
  • Shyam Singh Department of CVTS, SKIMS, Soura, Jammu Kashmir, India
  • Zubair Hakeem Department of CVTS, SKIMS, Soura, Jammu Kashmir, India
  • Farooq Ahmad Ganie Department of CVTS, SKIMS, Soura, Jammu Kashmir, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20183258

Keywords:

Mortality, Morbidity, Tetralogy of fallot, Transatrial repair

Abstract

Background: Right ventricular (RV) dysfunction is a significant cause of morbidity and mortality after surgical correction of RVOT obstruction including tetralogy of Fallot (TOF). Transatrial repair avoids a ventriculotomy (in contrast to the transventricular approach) emphasizing maximal preservation of RV structure and function. We have adopted this technique as less traumatic for the right ventricle. This study evaluates the early surgical results of our approach.

Methods: Between January 2005 to January 2014, 77 consecutive patients with RVOT obstruction were referred to our unit for surgical therapy. Of these, 14 were unsuitable for repair and underwent aortopulmonary shunting. In the remaining 63 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. In 51 patients, the main pulmonary artery was augmented with an autologous pericardial patch.

Results: There were 7 (9%) 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.

References

Anderson RH, Weinberg PM. The clinical anatomy of tetralogy of fallot. Cardiol Young. 2005;15 Suppl 1:38-47.

Marquis RM. Longevity and the early history of the tetralogy of Fallot. Br Med J. 1956;1(4971):819-22.

Evans WN. Tetralogy of Fallot and Etienne-Louis Arthur Fallot. Pediatr Cardiol. 2008;29(3):637-40.

Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002;39(12):1890-900.

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.

Karl TR, Sano S, Pornviliwan S, Mee RB. Tetralogy of Fallot: favorable outcome of non-neonatal transatrial transpulmonary repair. Ann Thorac Surg. 1992;54(5):903-7.

Rowlatt JF, Rimoldi HJ, Lev M. The quantitative anatomy of the normal child's heart, Pediatr Clin North Am. 1963;10:499-588.

Karl TR, Sano S, Pornviliwan S, Mee RB. Tetralogy of Fallot: favorable outcome of nonneanatal transatrial transpulmonary repair. Ann Thorac Surg. 1992;54(5):903-7.

Kawashima Y, Kitamura S, Nakano S, Yagihara T. Corrective surgery for tetralogy of Fallot without or with minimal right ventriculotomy and with repair of the pulmonary valve. Circulation. 1981;64:II147-153.

Pacifico AD, Sand ME, Bargeron LM, Calvin EC. Transatrial transpulmonary repair of tetralogy of Fallot. J Thorac Cardiovasc Surg. 1987;93:919-24.

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Published

2018-07-25

How to Cite

Wani, N. u din, Muzaffar, T., Ahangar, A. G., Sidiq, M. M., Lone, G. N., Dar, A. M., Lanker, A. M., Bhat, M. A., Singh, S., Hakeem, Z., & Ganie, F. A. (2018). Early results after transatrial repair of RVOT obstruction including teratology of fallot. International Journal of Research in Medical Sciences, 6(8), 2722–2725. https://doi.org/10.18203/2320-6012.ijrms20183258

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Original Research Articles