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THE JOURNAL OF CARDIOVASCULAR SURGERY

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The Journal of Cardiovascular Surgery 2000 February;41(1):17-21

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Complete atrioventricular septal defect associated with tetralogy of Fallot. Favourable outcome of transatrial transpulmonary repair

Schmid F.-X., Kampmann C. *, Hake U., Choi Y.-H., Wippermann F. *, Oelert H.

From the Depart­ment of Car­di­oth­o­racic and Vas­cular Sur­gery and *Pedi­atric Car­di­ology Uni­ver­sity Hos­pi­tals, ­Johannes Guten­berg Uni­ver­sity ­Mainz, ­Mainz, Ger­many


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Back­ground. Com­plete cor­rec­tion of atri­o­ven­tric­ular ­septal ­defect (­AVSD) asso­ciated ­with tet­ralogy of ­Fallot (TOF) has ­been ­reported to ­account for an ­increased sur­gical ­risk. ­Impaired ­right ven­tric­ular func­tion ­after ­classic trans­ven­tric­ular ­repair, ­residual out­flow ­tract sten­osis, and incom­pe­tence of the pul­mo­nary or atri­o­ven­tric­ular ­valves are con­sid­ered to be essen­tial fac­tors ­affecting the ­results.
­Methods. ­From 3/95 to 6/98 six con­sec­u­tive ­patients ­with ­AVSD and TOF under­went ­repair (age 18 ­months to 7.3 ­years) ­using a com­bined trans­atrial-trans­pul­mo­nary ­approach. RV out­flow ­tract bal­loon dil­a­ta­tion pre­ceded trans­atrial cor­rec­tion in 4 ­patients. Pul­mo­nary annu­lotomy but not trans­an­ular ­patching was nec­es­sary in 4 ­cases. The ­septal ­defects ­were ­closed by two sep­arate ­patches ­using a ­Dacron ­patch ­with ­short ­depth and ante­rior exten­sion for the ven­tric­ular com­po­nent.
­Results. All ­patients sur­vived and had ­stable ­sinus ­rhythm. Ech­o­car­di­og­raphy dem­on­strated ­mild, but hemo­dy­nam­i­cally insig­nif­i­cant ­mitral regur­gi­ta­tion in two and tri­cuspid regur­gi­ta­tion in ­four ­patients. ­Right ven­tricle to pul­mo­nary ­artery gra­dients ­ranged ­from 5 to 35 ­mmHg (­mean 24.2 ­mmHg) ­without pro­gres­sion. ­During ­follow-up ­ranging ­from 4 ­months to 3.5 ­years (­mean 16.8 ­months) no reop­er­a­tion was nec­es­sary.
Con­clu­sions. The trans­atrial-trans­pul­mo­nary ­approach for cor­rec­tion of ­AVSD ­with TOF con­trib­utes to ­improved ­results ­after ­repair of ­this ­rare com­bi­na­tion of ­defects.

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