28 years' experience with transatrial-transpulmonary repair of atrioventricular septal defect with tetralogy of Fallot.
BACKGROUND
The outcome of surgical correction of atrioventricular septal defect and tetralogy of Fallot has improved in recent years but is still reported to be associated with high mortality. Controversy exists about the need of a right ventriculotomy or a right ventricular to pulmonary artery conduit. The purpose of this study was to evaluate our results of atrioventricular septal defect and tetralogy of Fallot repair by transatrial-transpulmonary approaches.


METHODS
Between 1979 and 2007, 20 consecutive patients underwent correction of atrioventricular septal defect and tetralogy of Fallot. Five patients had undergone prior palliative shunts. In all patients, a transatrial-transpulmonary approach was used and repair was accomplished without a conduit. The two-patch technique was used to correct the atrioventricular septal defect. Clinical data were obtained by retrospective review of inpatient and outpatient clinical charts.


RESULTS
There was no in-hospital mortality and one late, noncardiac death. Six patients required eight reoperations, six for left atrioventricular valve insufficiency (repair: n = 4; replacement: n = 2), one for residual ventricular septal defect, and one for pulmonary artery branch obstruction. Follow-up was complete for all patients (median, 17 years; range, 1.5 to 28 years). All 19 survivors were in good clinical condition at last control, without medication, and in New York Heart Association class I (n = 18) or II (n = 1). Transesophageal echocardiography revealed good right ventricular function, low right ventricular outflow tract gradients (mean, 9 +/- 7.4 mm Hg), and trace pulmonary valve insufficiency (n = 11).


CONCLUSIONS
Atrioventricular septal defect and tetralogy of Fallot can be repaired with low mortality by the transatrial-transpulmonary approach without the use of a conduit.
Hoohenkerk
Gerard J F
GJ
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands. hoohenkerk@casema.nl
Schoof
Paul H
PH
Bruggemans
Eline F
EF
Rijlaarsdam
Mary
M
Hazekamp
Mark G
MG
D000293:Adolescent; D000328:Adult; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D006328:Cardiac Catheterization / Q000379:methods*; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006324:Heart Arrest, Induced; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000601:surgery; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D013771:Tetralogy of Fallot / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging / Q000601:surgery