28 years' experience with transatrial-transpulmonary repair of atrioventricular septal defect with tetralogy of Fallot

Autor: Paul H. Schoof, Mark G. Hazekamp, Eline F. Bruggemans, Gerard J.F. Hoohenkerk, Mary Rijlaarsdam
Rok vydání: 2007
Předmět:
Pulmonary and Respiratory Medicine
Adult
Heart Septal Defects
Ventricular
Male
Reoperation
congenital
hereditary
and neonatal diseases and abnormalities
medicine.medical_specialty
Cardiac Catheterization
Adolescent
Pulmonary Artery
Ventriculotomy
Heart Septal Defects
Atrial
Ventricular Outflow Obstruction
Blood Vessel Prosthesis Implantation
Postoperative Complications
medicine.artery
Internal medicine
medicine
Ventricular outflow tract
Humans
cardiovascular diseases
Atrioventricular Septal Defect
Heart Atria
Child
Tetralogy of Fallot
Retrospective Studies
Atrioventricular valve
Cardiopulmonary Bypass
business.industry
Pulmonary Artery Branch
Infant
medicine.disease
Surgery
Survival Rate
Child
Preschool
Pulmonary artery
cardiovascular system
Cardiology
Heart Arrest
Induced
Female
Pulmonary Valve Insufficiency
Cardiology and Cardiovascular Medicine
business
Echocardiography
Transesophageal
Follow-Up Studies
Zdroj: The Annals of thoracic surgery. 85(5)
ISSN: 1552-6259
Popis: 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.
Databáze: OpenAIRE
Externí odkaz: