[Current status of cardiac surgery for congenital heart disease-- tetralogy of Fallot and double outlet right ventricle].
In tetralogy of Fallot (TF) a new method of repair has been utilized since 1978. The method is transpulmonary and trans-atrial repair without or with minimal right ventriculotomy. Out of consecutive 81 patients, 79 patients underwent repair with this method with one operative death (operative mortality 1.3%). Postoperative hemodynamic evaluation revealed the better results in cardiac index, right ventricular endodiastolic volume and right ventricular ejection fraction. Also, pulmonary regurgitation has been reduced significantly compared to the conventional method with right ventriculotomy. The main criteria for total repair in TF is size of the pulmonary artery, and PA area Index (PA area/Normal R-PA area) over 0.20 is our minimal criteria to obtain postoperative right ventricular peak pressure ratio below 0.8. In double outlet right ventricle (DORV), operative mortality in last 5 years has improved to 19% (21 cases) from 68% of previous series. Six Taussig-Bing anomalies have undergone primary repair with 2 deaths. Various methods have been utilized including Kawashima 's method in 1 (0, op-death), Rastelli's method in 1(1), Hightower 's method in 1(0), and recently 2 patients had repair with Rastelli's operation with creating AP window to avoid subaortic obstruction. Also, Jatene operation (arterial switch) has been successfully performed in 8 month-old patient.
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D008722:Methods; D008875:Middle Aged; D011184:Postoperative Period; D013771:Tetralogy of Fallot / Q000503:physiopathology / Q000601:surgery*; D014188:Transposition of Great Vessels / Q000503:physiopathology / Q000601:surgery*