Total correction of complete atrioventricular septal defect with tetralogy of Fallot.
OBJECTIVE
The authors' experience in surgical management of tetralogy of Fallot in association with complete atrioventricular septal defect (CAVSD-TOF) is reported.


METHODS
Between January 1990 and September 2001, 146 children with CAVSD underwent complete correction. ASD closure was performed using a one-patch technique, with autologous pericardial patch. Seventeen patients presented with CAVSD-TOF, of whom nine (53%) had undergone previous palliation. Mean age at repair was 2.9 +/- 1.9 years. The mean gradient across the right ventricular outflow tract (RVOT) was 63 +/- 16 mmHg. Six patients (35%) required a transannular patch.


RESULTS
Overall in-hospital mortality was 10%. Among patients with CAVSD-TOF, three died in hospital (18%); causes of death were progressive heart failure (n = 2) and multiple organ failure (n = 1). Two patients required mediastinal exploration due to significant bleeding, and two late reoperation for severe left atrioventricular valve regurgitation after intracardiac repair. Mean follow up was 36 +/- 34 months. All patients survived and are currently in NYHA class I or II. At follow up, mean gradient across the RVOT was 17 +/- 6 mmHg, significantly less than the preoperative value (p < 0.001).


CONCLUSIONS
Complete repair in patients with CAVSD-TOF offers acceptable early and mid-term outcome in terms of mortality, morbidity and reoperation rate. Palliation prior to repair may be preferred in cases with small pulmonary arteries, or in severely cyanotic neonates. The RVOT should be managed as for isolated TOF, but a transatrial-transpulmonary approach is the surgery of choice.
Prifti
Edvin
E
Division of Pediatric Cardiac Surgery, G. Pasquinucci Hospital, CREAS-IFC-CNR, Massa, Italy.
Crucean
Adrian
A
Bonacchi
Massimo
M
Bernabei
Massimo
M
Luisi
Vincenzo Stefano
VS
Murzi
Bruno
B
Vanini
Vittorio
V
D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D002669:Child Welfare; D002675:Child, Preschool; D018618:Echocardiography, Doppler, Color; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006344:Heart Septal Defects, Atrial / Q000401:mortality / Q000601:surgery*; D006345:Heart Septal Defects, Ventricular / Q000401:mortality / Q000601:surgery*; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007223:Infant; D007229:Infant Welfare; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012086:Reoperation; D012720:Severity of Illness Index; D013771:Tetralogy of Fallot / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000151:congenital / Q000401:mortality / Q000601:surgery