title: Postoperative long-term results in total correction of tetralogy of Fallot: with special reference to method and degree of relief of right ventricular outflow tract obstruction.
abstract: Late results were studied in 63 patients who underwent complete repair of tetralogy of Fallot. Mild pulmonary stenosis (PS) was present in 73%, moderate PS in 17% and severe PS in 10% of the patients. When a transannular patch was used, wider enlargement of the pulmonary annulus did not always relate to a decrease in right ventricular pressure and right ventricular to pulmonary artery pressure gradient in the late postoperative period. Pulmonary regurgitation (PR) of grade 2 or less did not relate to the late postoperative hemodynamics and cardiac function. PR of grade 3 or over led to right ventricular and pulmonary artery hypertension, and to increases in right ventricular end-diastolic volume and CTR. PR of grade 4 impaired left ventricular function. PR of grade 3 or over with moderate PS led to elevation in right ventricular end-diastolic pressure. In patients with mild PS and PR of grade 2 or less, late postoperative hemodynamics and cardiac function were excellent. To maintain excellent postoperative hemodynamics and cardiac function, it is imperative to obtain PR of grade 2 or less and to use a procedure which will lead to excellent development of the pulmonary annulus. In conventional procedures using a transannular patch, a CSAI of less than 2.5 cm2/m2 and precise coaptation between the original pulmonary cusp and the cusp mounted on the patch will aid in avoiding significant PR.
mesh_terms: D000293:Adolescent; D000328:Adult; D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006321:Heart / Q000503:physiopathology; D006350:Heart Valve Prosthesis; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D011664:Pulmonary Valve / Q000601:surgery; D011665:Pulmonary Valve Insufficiency / Q000601:surgery; D011666:Pulmonary Valve Stenosis / Q000601:surgery; D013771:Tetralogy of Fallot / Q000503:physiopathology / Q000601:surgery*