Total transatrial correction of tetralogy of Fallot: no outflow patch technique.
BACKGROUND
The aim of this study was to analyze the feasibility and early results of transatrial total correction of tetralogy of Fallot (TOF).


METHODS
Of the 860 patients undergoing total correction for TOF between January 2000 and July 2005, 334 patients were considered morphologically suitable for transatrial total correction. The ventricular septal defect (VSD) closure, infundibular resection, and pulmonary valvotomy were performed through the right atrium without a right ventriculotomy. Age ranged from 6 months to 40 years (median, 2.8 years), and weight ranged from 5.5 to 70 kg (median, 14 kg).


RESULTS
Peroperatively, 34 patients required right ventriculotomy and transannular patch; hence, they were excluded from the study. In addition, pulmonary arteriotomy was required in 71 patients (22.9%). There were 4 hospital deaths. There were 4 early reoperations (residual/additional VSD in 3 and tricuspid regurgitation in 1). Two patients had complete heart block requiring permanent pacemaker. Echocardiography at discharge showed a peak right ventricular outflow tract gradient of 20 +/- 5.2 mm Hg. Mean follow-up was 26.8 +/- 4.2 months (range, 1 to 52 months). The right ventricular outflow tract gradients reduced to 13 +/- 4.2 mm Hg after a mean interval of 18.8 +/- 5.2 months. Follow-up New York Heart Association class was I in 240 cases (82%), II in 49 (16%), and III in 7 (2%). There were no late deaths or reoperations.


CONCLUSIONS
Transatrial total correction of TOF can be accomplished in selected patients with good early results. In 300 cases (90%), the feasibility of transatrial total correction could be predicted accurately.
Airan
Balram
B
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India. iactscon_2004@yahoo.co.in
Choudhary
Shiv Kumar
SK
Kumar
Honnakere Venkataiya Jayanth
HV
Talwar
Sachin
S
Dhareshwar
Jayesh
J
Juneja
Rajnish
R
Kothari
Shyam Sunder
SS
Saxena
Anita
A
Venugopal
Panangipalli
P
D006348:Cardiac Surgical Procedures / Q000379:methods*; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006325:Heart Atria / Q000601:surgery; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D018579:Patient Selection; D013771:Tetralogy of Fallot / Q000601:surgery*; D016896:Treatment Outcome