Atrioventricular septal defect can present with one or more associated anomalies. Cor triatriatum (subdivided left atrium) and vascular rings are among the less frequent. We describe a two-month-old patient with these three cardiovascular anomalies. This case highlights the importance of exhaustive preoperative evaluation in order to achieve successful surgical correction in one stage.
Background: The aim of this study is to evaluate the short-term results of surgical correction of Tetralogy of Fallot in adult patients. Methods: Between 1999 and 2007, surgical correction was performed in 16 adult patients (mean age: 34.6 years; range: 18 to 62). Five previous procedures had been performed in 4 patients. Thirteen patients were in NYHA functional classification III or IV (81%), and 12 were cyanotic. Echocardiography was performed in all patients and 14 of them were catheterized. The mean gradient in the right ventricular outflow tract was 82 mmHg. Four patients had unfavorable anatomy, consisting in coronary fistulas (2) and small pulmonary artery branches (2). Results: Infundibular resection was performed in all patients, ventricular septal defect closure in 15, pulmonary valve commissurotomy in 8, right ventricular outflow tract patch enlargement in 9 and transannular patch placement in 4. Three patients died during the postoperative hospital stay, 2 of them due to sepsis. All of them had unfavorable anatomy and impaired preoperative condition. No residual defects were found. The other 13 patients had a good recovery. Eleven had less than 24 hours of mechanical ventilation. Early hospital discharge was possible in all survivors. Conclusion: Surgical correction of Tetralogy of Fallot in adulthood is an infrequent procedure. The short-term results depend mostly on the anatomic substrate and the preoperative clinical condition of the patient.
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