title: Total transatrial correction of tetralogy of Fallot: no outflow patch technique.
abstract: 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.
authors.affiliation: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India. iactscon_2004@yahoo.co.in
authors.forename: Balram
authors.initials: B
authors.lastname: Airan
authors.forename: Shiv Kumar
authors.initials: SK
authors.lastname: Choudhary
authors.forename: Honnakere Venkataiya Jayanth
authors.initials: HV
authors.lastname: Kumar
authors.forename: Sachin
authors.initials: S
authors.lastname: Talwar
authors.forename: Jayesh
authors.initials: J
authors.lastname: Dhareshwar
authors.forename: Rajnish
authors.initials: R
authors.lastname: Juneja
authors.forename: Shyam Sunder
authors.initials: SS
authors.lastname: Kothari
authors.forename: Anita
authors.initials: A
authors.lastname: Saxena
authors.forename: Panangipalli
authors.initials: P
authors.lastname: Venugopal
mesh_terms: 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