title: Surgical results after total transatrial/transpulmonary correction of tetralogy of Fallot.
abstract: BACKGROUND
  Surgical repair of tetralogy of Fallot is associated with low early morbidity and mortality. However, there may be late morbidity and mortality due to right ventricular dysfunction. The transatrial/transpulmonary technique may ameliorate these long-term complications. Here we present the results from our use of this approach.
  
  
  METHODS
  A hundred sixty-three consecutive patients (age 6 months to 45 years, median 1.5 years) underwent transatrial/transpulmonary total correction in our department. In 142 patients the main pulmonary artery was augmented by an autologous pericardial patch, in 31 cases the arterioplasty was extended to the pulmonary artery branches, and pulmonary artery valvuloplasty was needed in 129 patients. A monocusp autologous pericardial valve mechanism was inserted in 14 patients.
  
  
  RESULTS
  Patient follow up was 100% complete with a median duration of 3.05 years. There were no deaths. One patient required early reoperation to relieve residual right ventricular outflow tract (RVOT) obstruction. Median ICU and hospital stay were 3 and 11 days, respectively. At hospital discharge RVOT gradient was 13.7 +/- 13 (median 10) mmHg, while most patients (94%) had up to moderate pulmonary valve insufficiency (1 + in 63.8%, 2+ in 30.6%), and normal (92.6%) or mildly reduced (6.1%) right ventricular function. In 81% some degree of tricuspid regurgitation was noted. One patient required late reoperation for mitral valve repair. All patients are in NYHA class I or II. The degree of pulmonary valve insufficiency remains stable (69.9% with 0-1 + and 24.5% up to 2+). Likewise, tricuspid valve function remains unchanged (96% of the patients had mild or up to moderate regurgitation). There was no significant RVOT obstruction and in most patients (93.2%) right ventricular function was normal.
  
  
  CONCLUSIONS
  These results compare very favorably to those reported in the literature. The medium-term findings auger well for future adverse event rates, but long-term follow up is still necessary to confirm them.
authors.affiliation: Department of Pediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Center, Athens, Greece. nickgia@hol.gr
authors.forename: Nicolaos M
authors.initials: NM
authors.lastname: Giannopoulos
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Chatzis
authors.forename: Alexandros I
authors.initials: AI
authors.lastname: Tsoutsinos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Bobos
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kontrafouris
authors.forename: Michael
authors.initials: M
authors.lastname: Mylonakis
authors.forename: George
authors.initials: G
authors.lastname: Kirvassilis
authors.forename: Ioanna
authors.initials: I
authors.lastname: Sofianidou
authors.forename: Prodromos
authors.initials: P
authors.lastname: Zavaropoulos
authors.forename: George E
authors.initials: GE
authors.lastname: Sarris
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000517:prevention & control; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000601:surgery; D012086:Reoperation; D013771:Tetralogy of Fallot / Q000601:surgery*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000517:prevention & control