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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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