[Current trends in heart surgery for the treatment of congenital anomalies: tetralogy of Fallot and its variants].
The surgical repair of tetralogy of Fallot is one of the most common procedures to correct congenital cardiac anomalies. However, controversy remains regarding the benefits and drawbacks of early primary repair. The management of patients with pulmonary atresia has become more aggressive in recent years, i.e., earlier primary repair with complete unifocalization is performed even if they have associated major aortopulmonary collateral arteries. On the other hand, the durability of small-sized conduits is unsatisfactory, and the rate of freedom from reoperation for those who received conduits in infancy is still low. Ventricular arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot are disastrous complications in adult survivors, but it remains difficult to predict which patients will experience such complications. Sustained ventricular tachycardia with pulmonary regurgitation is the predominant hemodynamic lesion. Achieving complete relief of the pressure gradient in the right ventricular outflow tract with no pulmonary regurgitation is the ultimate goal of surgical treatment of tetralogy of Fallot and its variants.
Katogi
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Division of Cardiovascular Surgery, School of Medicine, Keio University, Tokyo, Japan.
D000328:Adult; D003097:Collateral Circulation; D005500:Follow-Up Studies; D006801:Humans; D018633:Pulmonary Atresia / Q000601:surgery; D012086:Reoperation; D013771:Tetralogy of Fallot / Q000601:surgery*