The current strategy of repair of tetralogy of Fallot in children and adults.
OBJECTIVE
The strategies of repair of tetralogy of Fallot change with the age of patients. In children older than 4 years and adults, the optimal strategy may be to use different method of reconstruction of the right ventricular outflow tract from those followed in younger children, so as to avoid, or reduce, the pulmonary insufficiency that is increasingly known to compromise right ventricular function.


METHODS
From April, 2001, through May, 2008, we undertook complete repair in 312 patients, 180 male and 132 female, with a mean age of 11.3 years +/-0.4 years, and a range from 4 to 48 years, with typical clinical and morphological features of tetralogy of Fallot, including 42 patients with the ventriculo-arterial connection of double outlet right ventricle. The operation was performed under moderate hypothermia using blood cardioplegia. The ventricular septal defect was closed with a Dacron patch. When it was considered necessary to resect the musculature within the right ventricular outflow tract, or perform pulmonary valvotomy, we sought to preserve the function of the pulmonary valve by protecting as far as possible the native leaflets, or creating a folded monocusp of autologous pericardium.


RESULTS
The repair was achieved completely through right atrium in 192, through the right ventricular outflow tract in 83, and through the right atrium, the outflow tract, and the pulmonary trunk in 36 patients. A transjunctional patch was inserted in 169 patients, non-valved in all but 9. There were no differences regarding the periods of aortic cross-clamping or cardiopulmonary bypass. Of the patients, 5 died (1.6%), with no influence noted for the transjunctional patch. Of those having a non-valved patch inserted, three-tenths had pulmonary regurgitation of various degree, while those having a valved patch had minimal pulmonary insufficiency and good right ventricular function postoperatively, this being maintained after follow-up of 8 to 24-months.


CONCLUSIONS
Based on our experience, we suggest that the current strategy of repair of tetralogy of Fallot in older children and adults should be based on minimizing the insertion of transjunctional patches, this being indicated only in those with very small ventriculo-pulmonary junctions. If such a patch is necessary, then steps should be taken to preserve the function of the pulmonary valve.
He
Guo-Wei
GW
TEDA International Cardiovascular Hospital, Nankai University, Tianjin, China. gwhe@cuhk.edu.hk
Liu
Xiao-Cheng
XC
Kong
Xiang-Rong
XR
Liu
Li-Xin
LX
Yan
Ying-Qun
YQ
Chen
Bao-Jun
BJ
Li
Zong-Xiao
ZX
Jing
Wen-Bin
WB
Wang
Zheng-Qing
ZQ
Wang
Kai
K
Zhang
Wei
W
Chen
Tie-Nan
TN
Wang
Ping-Shan
PS
Lu
Wan-Li
WL
Zhang
Jian-Liang
JL
Guo
Zhi-Peng
ZP
Xue
Lan-Gang
LG
Zhu
Yu-Xiang
YX
Wang
Xiu-Li
XL
Xi
Lei
L
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002315:Cardiopulmonary Bypass; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D002681:China; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000637:transplantation*; D011093:Polyethylene Terephthalates; D011664:Pulmonary Valve / Q000601:surgery*; D013771:Tetralogy of Fallot / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D016278:Ventricular Function, Right / Q000502:physiology; D055815:Young Adult
D011093:Polyethylene Terephthalates