Among 814 patients undergoing repair of tetralogy of fallot with pulmonary stenosis between 1967 and may 1986, transannular patching in the current era was a weak risk factor for death early postoperatively predicted 30day mortality, 4% with a transannular patch and 1. Tetralogy of fallot, a congenital heart defect, can be mild or lifethreatening. Transannular patching was used in 99 patients 52%, patch closure of a right ventriculotomy in 35. Pitkanen, eero jokinen, heikki sairanen, need of transannular patch in tetralogy of fallot surgery carries a higher risk of reoperation but has no impact on late survival. Surgical strategies protecting against right ventricular. Signs and symptoms of the heart defect usually occur during the first weeks of life. In tetralogy of fallot, whether relieving right ventricular outflow tract obstruction requires transannular patch enlargement tape of the pulmonary valve depends on pulmonary valvular annulus size.
Tetralogy of fallot tof is one of the most common congenital heart diseases for which patients are referred for postoperative magnetic resonance mr imaging evaluation. The other is a complete repair of the two most important abnormalities that make up tetralogy of fallot. Some children can have other heart defects along with tetralogy of fallot. Valvesparing surgery for tetralogy of fallot procedure. This animation, fourth in a set of four, depicts blood flow through the right atrium, into the right ventricle and out the pulmonary artery. The pulmonary valvesparing approach to repairing tetralogy of fallot can be performed successfully in as many as 80% of the patients in which its attempted. It is a complex heart condition, however, and its symptoms resemble those related to other conditions. Reoperations are no more frequent that with the use of transannular patches. Total repair of tetralogy of fallot radiology reference.
Enlargement of the outflow tract is a basic concept in the surgical correction of heart disease with right ventricular obstruction, such as tetralogy of fallot tof. Need of transannular patch in tetralogy of fallot surgery carries a. Backgroundin tetralogy of fallot, transannular patching is suspected to be responsible for late right ventricular dilatation methods and resultsin our institution, 191 patients survived a tetralogy of fallot repair between 1964 and 1984. What is the optimal age for repair of tetralogy of fallot. The four defects include a ventricular septal defect vsd, pulmonary valve stenosis, a misplaced aorta and a thickened right ventricular wall right ventricular hypertrophy. This case illustrates the feasibility of cardiac rest on extracorporeal membranous oxygenation for a very ill adult with conduit endocarditis who received a right ventricletopulmonary artery valveless conduit for later transcatheter pulmonary valve.
Some degree of right ventricular failure is nearly universal following repair of tetralogy of fallot. Blood pressure against the defective bovine pericardial transannular patch creates an aneurysm, which grows substantially larger until it bursts. Pdf ventricular arrhythmia and tetralogy of fallot repair. Tetralogy of fallot tof is an important lesion for all pediatric and congenital heart surgeons. Tetralogy of fallot pediatrics merck manuals professional. Longterm outcome in patients undergoing surgical repair. Opinions differ regarding the timing of surgeryincluding the need for a palliative systemictopulmonary artery shunt prior to complete repair, the.
Use of a pulmonary neovalve with a transannular patch for repair. Tetralogy of fallot animation part 4 anatomical justice. Tetralogy of fallot congenital heart defects treatment. Seven years of followup after correction of tetralogy of fallot revealed that transannular patch reconstruction is not a cause of tendency for ventricular arrhythmia according to lown criteria. Although recent literature has focused on the deleterious effects of pulmonary regurgitation, inadequate relief of stenosis may increase postoperative mortality and the reintervention rate. Introduction in patients with tetralogy of fallot tof, use of transannular patch tap may be required in order to relieve significant right ventricular outflow tract obstruction, subsequently res.
Overall mortality following the repair of tetralogy of fallot is low. Get a second opinion for tetralogy of fallot from the herma heart institute. Monocusp valve placement in children with tetralogy of. Transannular patching is a valid alternative for tetralogy of fallot and complete atrioventricular septal defect repair. Our objective is to evaluate early and midterm results of pulmonary leaflets sparing with infundibular preservation and tricuspid valve repair in. The natural history of tetralogy of fallot depends on whether a transannular pulmonary valve patch or shunt surgery was necessary in infancy.
Mar 02, 2011 the structure of a heart with tetralogy of fallot tof the childrens hospital of philadelphia duration. Surgical strategies like pulmonary leaflets sparing and tricuspid valve repair at time of primary repair may decrease rv overload. Although the society of thoracic surgeons congenital database has been instrumental in the understanding of hospital outcomes following the repair of tetralogy of fallot tof, insights into the mid and longterm results are less concrete. Tetralogy of fallot, survival, transannular patch, late results, populationbased introduction tetralogy of fallot tof is found in 3. Longterm outcome in patients undergoing surgical repair of. Learn more from webmd about the symptoms and treatment of this condition. The child or adolescent with repaired tetralogy of fallot. Tetralogy of fallot is most often diagnosed in the first few weeks of life due to either a loud murmur or cyanosis. The asd was closed using the patch of autologous pericardium. Most patients with tetralogy of fallot tof undergo elective surgical repair between 3 and 6 months of age 15. Need of transannular patch in tetralogy of fallot surgery carries a higher risk of reoperation. Monoscusp valve placement in children with tetralogy of.
The aim of this study was to detect ventricular arrhythmia incidence and to find out the relationship between ventricular arrhythmia and the transannular and infundibular patch repair techniques to correct tetralogy of fallot. If possible, pulmonary valve function is preserved by avoiding a transannular patch closure of vsd dacron patch to relieve rvoto pulmonary valvotomy, the insertion of an outflow. Methods and resultsin our institution, 191 patients survived a tetralogy of fallot repair between 1964 and 1984. The structure of a heart with tetralogy of fallot tof the childrens hospital of philadelphia duration. Some patients may require earlier correction in the setting of severe cyanosis. Tetralogy of fallot causes decreased blood flow to the lungs.
Normally, the oxygenpoor blood in the heart flows from the right ventricle through the pulmonary artery, to the lungs to receive oxygen and then return to the left ventricle to be pumped back out to the body. Regurgitation was mild in 19 cases and moderate in 2 the first and second in the series. Tetralogy of fallot tof is the third most common congenital heart defect and the most common form of congenital heart disease to cause cyanosis. Ventricular arrhythmia and tetralogy of fallot repair with. They finally concluded that rvot reconstruction in tof, using only a limited transannular incision and a stiff dacron patch, that restricts the pulmonary annulus. More information for parents of children with tetralogy of fallot what causes it. Previously a routine technique, making a large incision in the right ventricle ventriculotomy and using a large transannular patch to repair tof, have been abandoned.
A patch across the pulmonary valve annulus a transannular patch is often required in order to adequately relieve right ventricular outflow tract obstruction. Tetralogy of fallot is a combination of four congenital abnormalities. Transannular patching is used to relieve significant pulmonary annular stenosis during tetralogy of fallot repair. If the predicted prvjlv is higher than the acceptable value selected by the surgeon, a transannular patch is constructed. Tetralogy of fallot results in low oxygenation of blood. Complete repair of tetralogy of fallot in the neonate. A traditional procedure involves closing the ventricular septal defect and placing a transannular patch a patch across the pulmonary valve connective tissue to. Tetralogy of fallot does have fallots four components. The childrens hospital of philadelphia 103,000 views. Longterm survival of patients with tetralogy of fallot with or without a patch up to or through the pulmonary. Pdf ventricular arrhythmia and tetralogy of fallot. The most common physical finding for a child or adolescent with repaired tetralogy of fallot tof is a residual heart murmur. The sts database reported the recent trend in tof operations, which revealed over 60% surgeries still using transannular patch enlargement. Tetralogy of fallot tof is a congenital heart defect.
In our centre, fallot tetralogy is the most common form of cyanotic congenital heart disease including transannular patch and accounts for 7. Management strategies, by peter lang, md, for openpediatrics. Transannular patching is a valid alternative for tetralogy of. Effect of transannular patching on outcome after repair of. Need of transannular patch in tetralogy of fallot surgery. Tetralogy of fallot is very treatable, most often requiring surgery before a childs first birthday. Symptoms include cyanosis, dyspnea with feeding, poor growth, and hypercyanotic tet. Transannular patching is a valid alternative for tetralogy. This is due to a mixing of oxygenated and deoxygenated blood in the left ventricle via the ventricular septal defect vsd and preferential flow of the mixed blood from both ventricles through the aorta because of the obstruction to flow through the pulmonary valve. Right ventricular outflow tract obstruction was relieved by transannular patch in 14 cases 42%, infundibular patch with preservation of the pulmonary valve in 7. The total predicted postrepair pa,, without a transannular patch is the sum of the predicted prv,lv in figs 1 and 3.
The zscore of pulmonary annulus is most commonly used as a predictor of the need for tape. Preservation of the pulmonary annulus in tetralogy of fallot has been reported as 80% by yasui et al 12 when a concerted effort toward preservation was made. The problems related with primary repair for tetralogy of fallot. Jun 29, 20 tetralogy of fallot tof is one of the most common congenital heart diseases for which patients are referred for postoperative magnetic resonance mr imaging evaluation. Tetralogy of fallot symptoms and causes mayo clinic. T1 transannular patching is a valid alternative for tetralogy of fallot and complete atrioventricular septal defect repair. The incidence of tetralogy of fallot tof among patients with atrioventricular septal defect avsd is estimated to be about 6% to 10%. Tetralogy of fallot with atrioventricular canal defect. Valvesparing surgery for tetralogy of fallot procedure details. Backgroundin tetralogy of fallot, transannular patching is suspected to be responsible for late right ventricular dilatation.
The original repair consisted of ventricular septal defect vsd closure through a large right ventriculotomy and right ventricular. Our study is a populationbased evaluation of the longterm results after surgical repair for tetralogy of fallot tof. Tetralogy of fallot, pediatric cardiac center delaware. The initial efforts at repair focused on the complete relief of obstruction across the right ventricular outflow tract rvot, usually including an aggressive resection of right ventricular. Transannular patching is a valid alternative for tetralogy of fallot and. The first anatomic repair of tof was performed in 1954. This is a guest commentary commissioned by the section editor xicheng deng department of cardiothoracic surgery, hunan childrens hospital, changsha, china. Tetralogy of fallot, pediatric cardiac center delaware valley. Our study is a populationbased evaluation of the long term results after surgical repair for tetralogy of fallot tof. Treatment of fallot tetralogy with a transannular patch. Significant resection of right ventricular muscle, coupled with pulmonary insufficiency resulting from transannular patch repair can lead to early postoperative hemodynamic instability. Tetralogy of fallot must be repaired with openheart surgery, either soon after birth or later in infancy. One provides temporary improvement by a shunt to give more blood flow to the lungs. In our institution, we showed a 100% survival rate at 10 years from the initial correction of tetralogy of fallot with transannular patch, which suggests that primary repair with transannular patch can be undertaken safely and effectively.
Cardiovascular mr imaging after surgical correction of. The most common surgical procedures for tof repair include infundibulectomy, transannular pulmonary artery patch repair, and right ventriclepulmonary artery conduit placement. Use of a dacron annular sparing versus limited transannular patch with nominal pulmonary annular expansion in infants with tetralogy of fallot. It may be seen more commonly in children with down syndrome or digeorge syndrome. In designing the most appropriate operation for children with tof, the postoperative physiology should be taken into account, both in the short and long term. Since the first procedures in the 1950s, advances in the diagnosis, perioperative and surgical treatment, and postoperative care have been such that almost all those born with tetralogy of fallot can now expect to survive to adulthood. Right ventricular rv volume overload increases morbidity and mortality after tetralogy of fallot tof repair. A novel predictive value for the transannular patch. Tof repair, ventriculotomy, transannular patch 370. Initial results using a transannular patch with a modified monocusp valve to repair the outflow tract in the tetralogy of fallot were promising. Tetralogy of fallot repair assumes vsd closure and relief of pulmonary stenosis at one or more levels, with use of a ventriculotomy incision and placement of a transpulmonary annulus patch. Although recent literature has focused on the deleterious effects of. Tof is described as 4 abnormalities that occur together. In most children, the cause of tetralogy of fallot isnt known.
Cardiac surgeons perform an open heart surgery during a childs first year to treat tetralogy of fallot. Patients might have one or both surgeries in their. Tetralogy of fallot is treated with two kinds of surgery. Babies with tetralogy of fallot usually have a patent ductus arteriosus at birth that provides additional blood flow to the lungs, so severe cyanosis is rare early after birth as the ductus arteriosus closes, which it typically will in the first days of life, cyanosis can. Tetralogy of fallot is the most common form of cyanotic congenital heart disease, and one of the first to be successfully repaired by congenital heart surgeons.
425 855 521 941 911 686 102 1207 458 621 217 323 89 1150 203 1446 972 246 1119 1121 1212 1026 1244 499 1585 957 1126 679 514 1204 18 1555 1572 189 1208 868 536 1442 1271 931 346 90 1072